Healthcare Provider Details

I. General information

NPI: 1548434871
Provider Name (Legal Business Name): DAVID J NYCZEPIR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 FOREST HILL AVE
RICHMOND VA
23235-3050
US

IV. Provider business mailing address

9015 FOREST HILL AVE
RICHMOND VA
23235-3050
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-7528
  • Fax:
Mailing address:
  • Phone: 804-272-7528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040100-7520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: