Healthcare Provider Details

I. General information

NPI: 1548554850
Provider Name (Legal Business Name): JAMES RIVER ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 SHRADER RD
RICHMOND VA
23294-4222
US

IV. Provider business mailing address

7820 SHRADER RD
RICHMOND VA
23294-4222
US

V. Phone/Fax

Practice location:
  • Phone: 804-672-8607
  • Fax: 804-672-8608
Mailing address:
  • Phone: 804-672-8607
  • Fax: 804-672-8608

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: DR. BRENT RUSNAK
Title or Position: OWNER
Credential: D.D.S.
Phone: 804-262-1060