| NPI | 1689899304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LYNN WARD Office Manager 703-960-1160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 6921) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |