| NPI | 1710013446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW TODD BRANDT President 540-886-2956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0438000220) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0438000074) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401410707) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-07-10 |