| NPI | 1669692547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J. KOKORELIS President 757-827-1572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401005924) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2008-06-16 |