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General NPI Number Information
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NPI Number | 1821425760
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Entity Type | Organization
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Legal Business Name | BON SECOURS VIRGINIA MEDICAL GROUP I, LLC
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 6900 FOREST AVE SUITE 110
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City | RICHMOND
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State | VA
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Zip | 23230-1729
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Country | US
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Telephone | 804-893-8715
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Fax | 804-285-1292
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Provider Business Mailing Address
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Address Line | 6900 FOREST AVE SUITE 110
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City | RICHMOND
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State | VA
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Zip | 23230-1729
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Country | US
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Telephone | 804-893-8715
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Fax | 804-285-1292
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Authorized Official
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Title or Position | DIRECTOR CORPORATE RESPONSIBILITY
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Name | GEORGE BUTLER
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Credential |
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Telephone | 804-281-0271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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