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Organization
VCU ORAL-FACIAL SURGERY AND SERVICES LLC
Active
Organization
VCU ORAL-FACIAL SURGERY AND SERVICES LLC
Active
Parent organization
DENTISTRY VCU
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTISTRY VCU
Authorized official
SANDY KROSLACK (CREDENTIALING SPECIALIST)
(904) 201-1428
Entity
Organization
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 628-6637
Mailing address
520 N 12TH ST, RICHMOND, VA 23298-5064
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X2210X
Orofacial Pain Dentistry
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
05/24/2021
Last updated
07/21/2023
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