Healthcare Provider Details

I. General information

NPI: 1184255101
Provider Name (Legal Business Name): JOHN T. WILL, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 10/26/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 RIVERSIDE DRIVE
DANVILLE VA
24541-5173
US

IV. Provider business mailing address

211 SPRUCE ST
CHARLOTTESVILLE VA
22902-5940
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-2142
  • Fax:
Mailing address:
  • Phone: 931-212-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: JOHN T. WILL
Title or Position: PRESIDENT
Credential: DDS
Phone: 931-212-3197