| NPI | 1750868097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE KEITH SOURS Owner/Dentist 703-369-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 401005467) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |