| NPI | 1588867113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TIMOTHY GOCKE Owner 703-388-2805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401411538) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0401411538) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: VA 0401411538) | |
| Enumeration Date | 2007-06-10 |
| Last Update Date | 2008-07-21 |