Individual
EISA JAWAD ABU MUNSHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4753 VALLEY VIEW BLVD NW, ROANOKE, VA 24012
(614) 282-0979
Mailing address
4753 VALLEY VIEW BLVD NW, ROANOKE, VA 24012-2000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401416557
VA
Other
Enumeration date
05/11/2017
Last updated
06/18/2019
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