| Dentistry VCU | |
|
520 N 12th St Richmond VA 23298-5064 | |
| (804) 828-9190 | |
| Not Available |
| Full Name | Dentistry VCU |
|---|---|
| Speciality | Dentist |
| Location | 520 N 12th St, Richmond, Virginia |
| Authorized Official Name and Position | Kimberly Jacobs (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 8048286514 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentistry VCU 520 N 12th St Richmond VA 23298-5064 | Dentistry VCU 520 N 12th St Richmond VA 23298-5064 Ph: (804) 828-9190 |
| NPI Number | 1790877504 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 07/20/2023 |
| Certification Date | 07/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790877504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (NU) | Secondary |
| 122300000X | Dentist | 005311 (Virginia) | Primary |
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