| NPI | 1790877504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JACOBS Director Of Finance 804-828-6514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 005311) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2023-07-20 |