| NPI | 1902261233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA M. CLARK Owner 757-467-7797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401414334) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2015-12-31 |