| NPI | 1700016995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNIE E. CHISHOLM Practice Administrator 540-832-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410495) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2015-07-28 |