Organization
VIRGINIA DEPARTMENT OF HEALTH
Active
Other names
Henrico County Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MELODY J. MCCORMICK (ADMINISTRATOR)
(804) 501-4953
Entity
Organization
Contact information
Practice address
8600 DIXON POWERS DR, RICHMOND, VA 23228-2735
(804) 504-4658
(804) 501-4588
Mailing address
8600 DIXON POWERS DR, RICHMOND, VA 23228-2735
(804) 504-4658
(804) 501-4588
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4975588
—
VA
01
—
ANTHEM
HMO
VA
Enumeration date
10/19/2006
Last updated
08/22/2020
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