| NPI | 1649289414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN HERIFORD Owner 757-539-1492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401006717) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401006896) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-08-22 |