# DENTISTRY VCU

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

## Provider details

- **NPI number:** 1790877504
- **Authorized official:** MS. KIMBERLY JACOBS (DIRECTOR OF FINANCE)
- **Authorized official phone:** (804) 828-6514

## Contact information

- **Practice address:** 520 N 12TH ST, RICHMOND, VA 23298-5064
- **Practice address phone:** (804) 828-9190
- **Mailing address:** 520 N 12TH ST, RICHMOND, VA 23298-5064

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 005311 | VA | Yes |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 07/20/2023