Healthcare Provider Details

I. General information

NPI: 1386011617
Provider Name (Legal Business Name): RICHMOND ORTHODONTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 PATTERSON AVE
RICHMOND VA
23229-6442
US

IV. Provider business mailing address

8503 PATTERSON AVE
RICHMOND VA
23229-6442
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-1297
  • Fax:
Mailing address:
  • Phone: 804-740-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BRITTANY G FRIDLEY
Title or Position: FINANCIAL COORDINATOR
Credential:
Phone: 804-740-1297