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Organization

VCU

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS WALDROP (PROGRAM DIRECTOR)
(804) 828-4867
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0442000290
VA

Other

Enumeration date
10/25/2016
Last updated
10/25/2016
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