| NPI | 1760578637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANDALE MARIE GREGORY Billing Financial Coordinator 757-486-5155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401004066) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401006323) |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401410052) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-09-14 |