Provider Demographics
NPI:1538259684
Name:MUSTIAN, EDWARD LOUIS III (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LOUIS
Last Name:MUSTIAN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10307 AVENHAM WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3692
Mailing Address - Country:US
Mailing Address - Phone:804-741-2045
Mailing Address - Fax:
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-285-9548
Practice Address - Fax:804-285-4887
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401005756OtherDENTAL LICENSE NUMBER