| NPI | 1912350547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANJA MANOJLOVIC Practice Administrator 757-838-8411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008873) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |