| NPI | 1578956793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY A MCDANIEL Dentist 757-898-6788 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412142) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412849) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |