| NPI | 1972740454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS IBANEZ President 434-823-7711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000261) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2018-11-14 |