| NPI | 1609358266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA DIAZ Owner 540-710-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412527) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |