| NPI | 1699668467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN RUCKER Owner 804-878-1069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-05-31 |
| Last Update Date | 2025-05-31 |