| NPI | 1861674699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAINE TRAVIS BOHRER Dentist 757-428-8282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410722) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-04 |