| NPI | 1821134636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEZLEY P MCILVEEN President Dentist 703-689-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401-006884) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401-007357) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401-006016) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2008-07-23 |