Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401414962 | VA |
NPI | 1003292871 |
---|---|
Provider Name | Dr. Robert Grant Steadman |
First Address | Richmond, VA 23235 |
Second Address | Richmond, VA 23235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 04/08/2015 |