Individual
JOHN PEROUTKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13321 MIDLOTHIAN TPKE STE C, MIDLOTHIAN, VA 23113-4270
(804) 794-5304
Mailing address
3614 HAWTHORNE AVE, RICHMOND, VA 23222-1824
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410896
VA
Other
Enumeration date
08/16/2006
Last updated
07/08/2007
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