Healthcare Provider Details

I. General information

NPI: 1982807285
Provider Name (Legal Business Name): NORMAN PRILLAMAN DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BROOK PARK PLACE
FOREST VA
24551
US

IV. Provider business mailing address

306 BROOK PARK PLACE
FOREST VA
24551
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-4499
  • Fax: 434-385-7944
Mailing address:
  • Phone: 434-385-4499
  • Fax: 434-385-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401008100
License Number StateVA

VIII. Authorized Official

Name: WILLIAM NORMAN PRILLAMAN II
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 434-385-4499