# VIRGINIA COMMONWEALTH UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639344641
- **Authorized official:** DR. ALFRED JOSEPH CERTOSIMO DMD (CHAIR, DEPT. OF GENERAL PRACTICE)
- **Authorized official phone:** (804) 828-2977

## Contact information

- **Practice address:** 520 N 12TH STREET, LYONS BLDG ROOM 414, RICHMOND, VA 23298-0566
- **Practice address phone:** (804) 828-2977
- **Practice address fax:** (804) 828-3159
- **Mailing address:** 520 N 12TH STREET, LYONS BLDG ROOM 414, RICHMOND, VA 23298-0566
- **Mailing address phone:** (804) 828-2977
- **Mailing address fax:** (804) 828-3159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401008264 | VA | Yes |

## Other

- **Enumeration date:** 04/30/2008
- **Last updated:** 04/30/2008