| NPI | 1881808475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STEPHEN CLOTH President 434-975-3013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401005851) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |