| NPI | 1891102554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK VAN RUSSELL VP Of Operations 240-320-7331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14531) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |