Healthcare Provider Details

I. General information

NPI: 1871356352
Provider Name (Legal Business Name): DARIAN ELIZABETH MOORE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N 25TH ST
RICHMOND VA
23223-6539
US

IV. Provider business mailing address

2809 NORTH AVE
RICHMOND VA
23222-3647
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-0840
  • Fax:
Mailing address:
  • Phone: 804-780-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402207644
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: