| NPI | 1598983314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HILARIO DIAZ President 703-455-5766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401411082) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |