| NPI | 1881106292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN THORNTON GILLIS Authorized Official 804-794-8745 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |