| NPI | 1730687526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB SHEPPARD Dentist 804-458-3004 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414898) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-01-26 |