| NPI | 1629216049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY DEWITT Office Manager 703-455-3338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 401411147) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410761) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2014-10-10 |