| NPI | 1689032641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LEE MUELLER President 804-360-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA M00159001) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2016-02-05 |