=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063374387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER RUN DENTAL OF VIRGINIA BEACH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2025
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 FIRST COLONIAL RD STE 101
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-659-5954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 FIRST COLONIAL RD STE 101
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCM DIRECTOR
-----------------------------------------------------
Name | KIM DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-568-5773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------