| NPI | 1699153619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTAL LYNN ALLEN-ROARK Practice Administrator 703-897-8554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410445) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |