| NPI | 1568632370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY L EZEKIEL Owner 757-867-5003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007624) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2008-03-07 |