Organization
VIRGINIA COMMONWEALTH UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBRA HASELTON (DIRECTOR OF AEGD)
(804) 828-3368
Entity
Organization
Contact information
Practice address
521 N 11TH ST, RICHMOND, VA 23298-5045
(804) 828-3368
Mailing address
521 N 11TH ST, RICHMOND, VA 23298-5045
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401414484
VA
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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