| NPI | 1760771679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI ROSS President 757-249-4203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 7301) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2011-03-31 |