| NPI | 1649485541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER GILLEN KUENZLI President Of Corporation 757-490-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401007122) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |