| NPI | 1649440736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE NICHOLS DICKSON Owner/Dentist 571-481-4410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410681) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2008-03-05 |