Provider Demographics
NPI:1861805392
Name:MUSTIAN, JOHN ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:MUSTIAN
Suffix:
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 1:1745 W CARY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5308
Mailing Address - Country:US
Mailing Address - Phone:804-405-8936
Mailing Address - Fax:
Practice Address - Street 1:5700 OLD RICHMOND AVE STE B8
Practice Address - Street 2:
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:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014144501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice