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General NPI Number Information
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NPI Number | 1548554850
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Entity Type | Organization
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Legal Business Name | JAMES RIVER ORTHODONTICS
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 7820 SHRADER RD
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City | RICHMOND
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State | VA
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Zip | 23294-4222
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Country | US
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Telephone | 804-672-8607
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Fax | 804-672-8608
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Provider Business Mailing Address
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Address Line | 7820 SHRADER RD
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City | RICHMOND
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State | VA
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Zip | 23294-4222
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Country | US
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Telephone | 804-672-8607
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Fax | 804-672-8608
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT RUSNAK
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Credential | D.D.S.
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Telephone | 804-262-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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