| NPI | 1861555740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY L HAYNES Financial Coordinator 804-739-9830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007260) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-22 |