Healthcare Provider Details

I. General information

NPI: 1285664961
Provider Name (Legal Business Name): TEGWYN BRICKHOUSE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N 11TH ST
RICHMOND VA
23298-5045
US

IV. Provider business mailing address

521 N 11TH ST
RICHMOND VA
23298-5045
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9095
  • Fax: 804-827-1244
Mailing address:
  • Phone: 804-828-9095
  • Fax: 804-827-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0411000034
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: