| NPI | 1891954319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK WRIGHT BROADHEAD Co Owner 540-635-4567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411086) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |