| NPI | 1629204334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCY LYNN MCCABE Gm 703-719-5828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: VA 0401003534) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2009-06-09 |