| NPI | 1891978029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL STOUT Owner 540-949-8053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA VA0401007125) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2007-12-11 |