| NPI | 1982425658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURI W HENDERSON Administrative Assistant 804-897-3600 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-24 |