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General NPI Number Information
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NPI Number | 1215292255
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Entity Type | Organization
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Legal Business Name | PAUL E. PRILLAMAN, III, DDS, PLC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 905 BATTLEFIELD BLVD N 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4875
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Country | US
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Telephone | 757-547-2820
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Fax | 757-547-4301
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Provider Business Mailing Address
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Address Line | 905 BATTLEFIELD BLVD N STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4875
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Country | US
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Telephone | 757-547-2820
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Fax | 757-547-4301
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAUL ELLIS PRILLAMAN III
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Credential | DDS
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Telephone | 757-547-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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