Healthcare Provider Details

I. General information

NPI: 1235453457
Provider Name (Legal Business Name): WILLIAM C BIGELOW, D.D.S., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MACTANLY PL STE C
STAUNTON VA
24401-2362
US

IV. Provider business mailing address

110 MACTANLY PL STE C
STAUNTON VA
24401-2362
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-8750
  • Fax: 540-213-8753
Mailing address:
  • Phone: 540-213-8750
  • Fax: 540-213-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000074
License Number StateVA

VIII. Authorized Official

Name: DR. WILLIAM C BIGELOW
Title or Position: OWNER
Credential: D.D.S.
Phone: 540-213-8750