# RIVER RUN DENTAL OF LIBBIE MILL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** River Run Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720795131
- **Authorized official:** CHAD HENDRICKS (CREDENTIALING)
- **Authorized official phone:** (612) 859-0444

## Contact information

- **Practice address:** 5001 LIBBIE MILL EAST BLVD STE 125, RICHMOND, VA 23230-2152
- **Practice address phone:** (804) 390-7133
- **Mailing address:** 5001 LIBBIE MILL EAST BLVD STE 125, RICHMOND, VA 23230-2152
- **Mailing address phone:** (804) 390-7133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |

## Other

- **Enumeration date:** 11/04/2022
- **Last updated:** 11/04/2022