| NPI | 1942950068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD CHRISTENSON Doctor/Owner 757-482-7660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-03-24 |