| NPI | 1669499422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORYDON B BUTLER Vice President 757-229-7210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-08-22 |