| NPI | 1619241122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURT S HASELMAN Owner/Dentist 804-272-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410264) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410247) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2012-03-01 |