| NPI | 1912110800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED ALBERT BUBERNAK Dentist 703-494-2545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 05126) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |