Individual
MRIDULA MANOJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1612 HUGUENOT RD, MIDLOTHIAN, VA 23113-2427
(804) 794-9789
Mailing address
3268 BROOK RD, RICHMOND, VA 23227-4835
(336) 803-5193
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418552
VA
Other
Enumeration date
04/01/2022
Last updated
09/07/2023
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