Individual
TEGWYN BRICKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
521 N 11TH ST, RICHMOND, VA 23298-5045
(804) 828-9095
(804) 827-1244
Mailing address
521 N 11TH ST, RICHMOND, VA 23298-5045
(804) 828-9095
(804) 827-1244
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0411000034
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018308
—
VA
05
—
01-0025621
—
VA
01
—
463655
ANTHEM BC/BS
VA
Enumeration date
07/05/2006
Last updated
12/14/2012
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