NPIMap

Organization Active NPI

Dentistry Vcu

  • Dentist
  • Richmond, VA
National Provider Identifier
1790877504
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
005311 Issued in VA
Legal business name
DENTISTRY VCU
Practice address
520 N 12TH St
Richmond, VA 23298-5064
Phone
(804) 828-9190
NPI assigned
Sep 29, 2006
Last updated
Jul 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU
Dentist 122300000X 005311 VA Primary

Addresses

Primary practice location

520 N 12TH St
Richmond, VA 23298-5064

Mailing address

520 N 12TH St
Richmond, VA 23298-5064

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1790877504",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 12TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985064",
            "telephone_number": "804-828-9190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTRY VCU",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "005311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jul 20, 2023; 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.