| NPI | 1730226648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN REASON Office Manager 757-499-6886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401-006024) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401-410256) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401-410239) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-07-21 |