| NPI | 1639259773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LEE PICENTE Practice Manager 703-449-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000163) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410440) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2011-05-25 |