| NPI | 1871010850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIA MILLER Accounting 276-466-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: VA 0401008559) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-07-21 |