Healthcare Provider Details

I. General information

NPI: 1003302472
Provider Name (Legal Business Name): VCU DIAGNOSTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST # 315
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

520 N 12TH ST # 315
RICHMOND VA
23298-5064
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES DONALD PARRIS
Title or Position: DIRECTOR, CLINICAL BUSINESS SERVICE
Credential:
Phone: 804-828-0789