| NPI | 1790835957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA DOUGLASS Office Manager 757-466-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401002827) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |