| NPI | 1841664927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIKA MADAN Periodontist/CEO 757-663-1633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401412643) |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2015-11-30 |