Organization
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Active
Other names
Bon Secours Pediatric Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH HARDY (CFO)
(937) 478-2932
Entity
Organization
Contact information
Practice address
6900 FOREST AVE, SUITE 110, RICHMOND, VA 23230-1701
(804) 893-8715
(804) 285-1292
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
02/24/2012
Last updated
10/05/2021
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