| NPI | 1790486827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEITH KALLAS Owner 703-622-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2023-12-18 |