| NPI | 1770012163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARTER LEE RICHARDS President 757-749-9043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401008839) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |