Healthcare Provider Details

I. General information

NPI: 1124386206
Provider Name (Legal Business Name): ADAMS AND ALLEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BROAD ST
RICHMOND VA
23220-4219
US

IV. Provider business mailing address

300 W BROAD ST
RICHMOND VA
23220-4219
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-2888
  • Fax: 804-643-1916
Mailing address:
  • Phone: 804-780-2888
  • Fax: 804-643-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401411279
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401004545
License Number StateVA

VIII. Authorized Official

Name: DR. RANDY ADAMS
Title or Position: OWNER
Credential: DDS
Phone: 804-780-2888