| NPI | 1962790261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW JASON SHANNON Dentist 571-230-8051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: VA 0401411773) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |