| NPI | 1649555681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI B HARRELSON Office Receptionist 434-707-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412538) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2011-10-20 |