| NPI | 1902819303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN LEIGH MASTROS Pres. 757-249-5128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: VA 0401411471) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2012-12-20 |