Healthcare Provider Details

I. General information

NPI: 1649575531
Provider Name (Legal Business Name): URSULA KLOSTERMYER DDS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 GLEN FOREST DR
RICHMOND VA
23226-3782
US

IV. Provider business mailing address

7204 GLEN FOREST DR
RICHMOND VA
23226-3782
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-7260
  • Fax: 804-282-7262
Mailing address:
  • Phone: 804-282-7260
  • Fax: 804-282-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401413297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: