| NPI | 1902329329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARTER M WALLER Dentist 540-899-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401410947) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: VA 0401415285) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2022-07-21 |