Healthcare Provider Details

I. General information

NPI: 1477396844
Provider Name (Legal Business Name): VCU PREDOCTORAL DENTAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

521 N 11TH ST
RICHMOND VA
23298-5016
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9190
  • Fax: 804-628-2001
Mailing address:
  • Phone: 804-628-7146
  • Fax: 804-628-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES DONALD PARRIS
Title or Position: DIRECTOR, PATIENT BUSINESS SERVICES
Credential:
Phone: 804-628-7146