Organization
DENTISTRY VCU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY JACOBS (DIRECTOR OF FINANCE)
(804) 828-6514
Entity
Organization
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-9190
Mailing address
520 N 12TH ST, RICHMOND, VA 23298-5064
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
005311
VA
122300000X
Dentist
—
—
Other
Enumeration date
09/29/2006
Last updated
07/20/2023
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