| NPI | 1902967649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY D STEWART Dentist 804-643-6665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410621) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401005152) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |