| NPI | 1720006661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER EUGENE BONACCI President 703-255-9400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: VA 0101057525) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: VA 0401102631) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-09-23 |