# VIRGINIA COMMONWEALTH UNIVERSITY

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

## Provider details

- **NPI number:** 1851708390
- **Authorized official:** DR. DEBRA HASELTON (DIRECTOR OF AEGD)
- **Authorized official phone:** (804) 828-3368

## Contact information

- **Practice address:** 521 N 11TH ST, RICHMOND, VA 23298-5045
- **Practice address phone:** (804) 828-3368
- **Mailing address:** 521 N 11TH ST, RICHMOND, VA 23298-5045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401414484 | VA | Yes |

## Other

- **Enumeration date:** 07/16/2014
- **Last updated:** 07/16/2014