| NPI | 1760811855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAI KOUSSA Dentist 703-663-8276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: VA 0401410151) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2013-11-08 |