| NPI | 1659567972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DWAYNE MADISON President 703-391-8836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401006578) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2007-09-20 |