| NPI | 1578807541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DAVID GRUNTZ Owner 703-412-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401006070) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |