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General NPI Number Information
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NPI Number | 1447588991
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 109 GOVERNOR ST
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City | RICHMOND
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State | VA
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Zip | 23219-3623
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Country | US
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Telephone | 804-864-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 109 GOVERNOR ST RM 927
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City | RICHMOND
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State | VA
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Zip | 23219-3623
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Country | US
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Telephone | 804-864-7774
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, OFFICE OF FAMILY HEALTH
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Name | DR. DAVID SUTTLE
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Credential | MD
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Telephone | 804-864-7650
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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 | VA
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