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General NPI Number Information
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NPI Number | 1386196343
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Entity Type | Organization
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Legal Business Name | RAPPAHANNOCK FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 4513 NEWPORT DR
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City | RICHMOND
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State | VA
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Zip | 23227-3723
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Country | US
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Telephone | 804-350-0994
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 NEWPORT DR
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City | RICHMOND
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State | VA
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Zip | 23227-3723
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Country | US
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Telephone | 804-350-0994
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL DENTIST
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Name | KRISTIN EDWARDS
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Credential | D.D.S.
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Telephone | 804-350-0994
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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 | 0401415285
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License Number State | VA
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