NPI | 1831408178 |
---|---|
Entity Type | Organization |
Authorized Contact | JUSTIN NEIL TEBBENKAMP Owner/President 540-961-3279 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412219) |
Enumeration Date | 2010-10-05 |
Last Update Date | 2010-10-05 |