| NPI | 1770130684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN HOWARD Credentialing Specialist 757-576-5479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2019-08-26 |