| NPI | 1568636587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI BYNUM Office Manager 757-547-2171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 4303VA) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-07-16 |