| NPI | 1568037471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JACOBS Director Of Finance 804-828-6514 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-05-24 |