| NPI | 1760682215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANI WILSON Financial Coordinator 804-827-1960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 442000073) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2007-07-23 |