Healthcare Provider Details

I. General information

NPI: 1750815437
Provider Name (Legal Business Name): LARRY DENSON JR. RCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HIOAKS RD SUITE# D
RICHMOND VA
23225-4038
US

IV. Provider business mailing address

10112 IRON MILL RD
NORTH CHESTERFIELD VA
23235-3934
US

V. Phone/Fax

Practice location:
  • Phone: 804-292-0968
  • Fax:
Mailing address:
  • Phone: 804-475-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number00026046
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: