Organization
VIRGINIA COMMONWEALTH UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFRED JOSEPH CERTOSIMO DMD (CHAIR, DEPT. OF GENERAL PRACTICE)
(804) 828-2977
Entity
Organization
Contact information
Practice address
520 N 12TH STREET, LYONS BLDG ROOM 414, RICHMOND, VA 23298-0566
(804) 828-2977
(804) 828-3159
Mailing address
520 N 12TH STREET, LYONS BLDG ROOM 414, RICHMOND, VA 23298-0566
(804) 828-2977
(804) 828-3159
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401008264
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153654
UNITED CONCORDIA
VA
01
—
453709
ANTHEM
VA
05
—
5894
—
VA
Enumeration date
04/30/2008
Last updated
04/30/2008
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