| NPI | 1720237811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEENAN M DAVIS Partner 757-588-1563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401005418) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411811) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401006401) | |
| 1223P0700X Dentist, Prosthodontics (Licence: VA 0401008797) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2008-09-12 |