Provider Demographics
NPI:1548534332
Name:VIRGINIA DENTAL SLEEP SOLUTIONS, LLC
Entity type:Organization
Organization Name:VIRGINIA DENTAL SLEEP SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ONEIL
Authorized Official - Last Name:MCMUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-972-0468
Mailing Address - Street 1:8804 PATTERSON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6361
Mailing Address - Country:US
Mailing Address - Phone:804-972-0468
Mailing Address - Fax:804-741-6009
Practice Address - Street 1:8804 PATTERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6361
Practice Address - Country:US
Practice Address - Phone:804-972-0468
Practice Address - Fax:804-741-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6685150001Medicare NSC