Organization
VCU DENTAL FACULTY PRACTICE, LLC
Active
Parent organization
DENTISTRY@VCU
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTISTRY@VCU
Authorized official
KIMBERLY JACOBS (DIRECTOR OF FINANCE)
(804) 828-6514
Entity
Organization
Contact information
Practice address
521 N 11TH ST, RICHMOND, VA 23298-5016
(804) 828-3368
Mailing address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-3769
(804) 628-2001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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