| NPI | 1619365293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS A. HERESI Doctor 571-218-5301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401412533) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |