| NPI | 1811352198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY SCOTT TROTTER President 757-838-3975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401008539) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |