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General NPI Number Information
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NPI Number | 1780858746
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Entity Type | Organization
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Legal Business Name | LAWRENCE R. MULLER, DDS, PC
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 04/21/2008
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Provider Practice Location Address
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Address Line | 3302 OLD BRIDGE RD STE F
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City | LAKE RIDGE
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State | VA
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Zip | 22192-5262
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Country | US
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Telephone | 703-497-9709
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 OLD BRIDGE RD STE F
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City | LAKE RIDGE
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State | VA
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Zip | 22192-5262
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Country | US
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Telephone | 703-497-9709
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE R MULLER
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Credential |
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Telephone | 703-497-9709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401007182
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License Number State | VA
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