| NPI | 1720695703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN HOWARD Credentialing Specialist 757-576-5479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2020-09-24 |