Provider Demographics
NPI:1285329052
Name:RICHMOND FAMILY DENTISTRY AT SHORT PUMP
Entity type:Organization
Organization Name:RICHMOND FAMILY DENTISTRY AT SHORT PUMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-308-2590
Mailing Address - Street 1:11736 W BROAD ST STE C-112
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11736 W BROAD ST STE C-112
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1189
Practice Address - Country:US
Practice Address - Phone:310-995-0492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty