| NPI | 1982293064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY GOGGANS President 703-574-2174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2021-01-13 |