| NPI | 1700060712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANO ANDRES POLACK Shareholder 703-753-8753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0186) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: VA 0556) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |