| NPI | 1699278804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMY ATTALLA Manager 804-539-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MI 2901021583) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021583) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901021630) | |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-03-14 |