Healthcare Provider Details

I. General information

NPI: 1275598906
Provider Name (Legal Business Name): BHAVNA SHROFF D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST VCU-ORTHODONTICS-LYONS BUILDING-SUITE #111
RICHMOND VA
23219-1610
US

IV. Provider business mailing address

520 N 12TH ST VCU-ORTHODONTICS-LYONS BUILDING-SUITE #111
RICHMOND VA
23219-1610
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9326
  • Fax: 804-828-5789
Mailing address:
  • Phone: 804-828-9326
  • Fax: 804-828-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401008304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: