NPIMap

Organization Active NPI

Vcu Dental Faculty Practice, LLC

  • General Practice Dentistry
  • Richmond, VA
National Provider Identifier
1568037471
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
VCU DENTAL FACULTY PRACTICE, LLC
Practice address
521 N 11TH St
Richmond, VA 23298-5016
Phone
(804) 828-3368
NPI assigned
May 24, 2021
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTISTRY@VCUAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Jacobs
Title
Director of Finance
Phone
(804) 828-6514

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary
Periodontics 1223P0300X NU
Prosthodontics 1223P0700X NU

Addresses

Primary practice location

521 N 11TH St
Richmond, VA 23298-5016

Mailing address

520 N 12TH St
Richmond, VA 23298-5064
Phone (804) 828-3769

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dentalcare@vcu.edu VCU Oral-Facial Surgery and Services LLC
Direct Messaging Address dentalcare@vcu.edu Dentistry VCU

National Provider Directory

National Provider Directory
Part of
Dental Faculty Pract As

Locations

521 N 11th St
Ste 417
Richmond, VA 23298

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1568037471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N 12TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985064",
            "telephone_number": "804-828-3769",
            "fax_number": "804-628-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 N 11TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985016",
            "telephone_number": "804-828-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VCU DENTAL FACULTY PRACTICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTISTRY@VCU",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "804-828-6514"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dentalcare@vcu.edu",
            "affiliation": "Y",
            "affiliationName": "VCU Oral-Facial Surgery and Services LLC",
            "address_1": "520 N 12th St",
            "city": "Richmond",
            "state": "VA",
            "country_code": "US",
            "postal_code": "232985064",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dentalcare@vcu.edu",
            "affiliation": "Y",
            "affiliationName": "Dentistry VCU",
            "address_1": "520 N 12th St",
            "city": "Richmond",
            "state": "VA",
            "country_code": "US",
            "postal_code": "232985064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.