Provider Demographics
NPI:1780239087
Name:RVA PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:RVA PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MUSSELWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-827-2975
Mailing Address - Street 1:7113 THREE CHOPT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-220-6188
Mailing Address - Fax:804-285-3121
Practice Address - Street 1:7113 THREE CHOPT RD
Practice Address - Street 2:STE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-220-6188
Practice Address - Fax:804-285-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty