| NPI | 1871957043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM THOMAS GOODWIN President 540-705-0195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401414700) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-05-10 |