Individual
LAURA R MALLINAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
604 E CHURCH ST, MARTINSVILLE, VA 24112-3008
(276) 632-2189
Mailing address
784 PLANTATION RD, MARTINSVILLE, VA 24112-0369
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411452
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9183678
—
VA
Enumeration date
06/05/2007
Last updated
07/08/2007
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