Healthcare Provider Details

I. General information

NPI: 1932274560
Provider Name (Legal Business Name): WILLIAM R ARMENTROUT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W GRACE ST
RICHMOND VA
23220-4911
US

IV. Provider business mailing address

517 W GRACE ST
RICHMOND VA
23220-4911
US

V. Phone/Fax

Practice location:
  • Phone: 804-783-2505
  • Fax: 804-783-2514
Mailing address:
  • Phone: 804-783-2505
  • Fax: 804-783-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401003807
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: