| NPI | 1669636890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JB MARTIN Owner 757-397-9801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401007603) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2008-07-16 |