| NPI | 1730391475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL EDWARD BOGACKI President 703-451-2867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401008712) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |