MEDICARE: DR. WILLIAM JAMES REDWINE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401004476	VA

General Provider Information

NPI Number	:	1841346350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JAMES REDWINE DDS

Provider Business Mailing Address
First Line	:	6808 STONEMAN ROAD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2700
Country	:	US
Telephone Number	:	804-266-8704
Fax Number	:	804-262-5071

Provider Business Practice Location Address
First Line	:	6808 STONEMAN ROAD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2700
Country	:	US
Telephone Number	:	804-266-8704
Fax Number	:	804-262-5071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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