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General NPI Number Information
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NPI Number | 1285264887
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Entity Type | Organization
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Legal Business Name | NORTHSIDE DENTAL COMPANY, PLLC
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 3404 HERMITAGE RD
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City | RICHMOND
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State | VA
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Zip | 23227-4307
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Country | US
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Telephone | 804-477-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 3404 HERMITAGE RD
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City | RICHMOND
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State | VA
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Zip | 23227-4307
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Country | US
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Telephone | 804-767-3410
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Fax | 804-934-9291
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KATELIN HEIM
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Credential |
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Telephone | 804-767-3410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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