| NPI | 1609251503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSCAR G. VEGA Owner 540-948-4488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401413659) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: VA 0401004401) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2015-07-21 |