| NPI | 1790661049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM ERVIL Owner 804-615-9682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist |
| 1223E0200X Dentist Endodontics | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223X0008X Dentist Oral and Maxillofacial Radiology | |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2025-08-13 |