| NPI | 1629814652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SULLIVAN Director Of Operations 703-965-8658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-07-09 |