| NPI | 1659488088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY LEE GREEN President 757-874-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA VA4239) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-22 |