| NPI | 1841536364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK WRIGHT BROADHEAD Owner 540-635-4567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401411086) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: VA 0401413785) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2013-01-03 |