| NPI | 1720520794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANA D GRAHAM-MONTAQUE Owner/Pediatric Dentist 804-640-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401411505) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-08 |