MEDICARE: VIRGINIA DENTAL SLEEP SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401005193	VA

General Provider Information

NPI Number	:	1548534332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA DENTAL SLEEP SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	8804 PATTERSON AVE
Second Line	:	SUITE 100
City	:	RICHMOND
State	:	VA
Zip	:	23229-6361
Country	:	US
Telephone Number	:	804-972-0468
Fax Number	:	804-741-6009

Provider Business Practice Location Address
First Line	:	8804 PATTERSON AVE
Second Line	:	SUITE 100
City	:	RICHMOND
State	:	VA
Zip	:	23229-6361
Country	:	US
Telephone Number	:	804-972-0468
Fax Number	:	804-741-6009

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MICHAEL ONEIL MCMUNN
Credential	:	DDS
Telephone Number	:	804-972-0468

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	06/20/2012

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