Healthcare Provider Details

I. General information

NPI: 1073281168
Provider Name (Legal Business Name): SUSAN PHARR RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 NEWQUAY LN
RICHMOND VA
23236-1362
US

IV. Provider business mailing address

2720 NEWQUAY LN
RICHMOND VA
23236-1362
US

V. Phone/Fax

Practice location:
  • Phone: 804-690-5436
  • Fax:
Mailing address:
  • Phone: 804-690-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402000827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: