| NPI | 1801335989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN LEE RICKS Office Manager 757-484-4197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410824) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |