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General NPI Number Information
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NPI Number | 1891362307
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Entity Type | Individual
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Provider Name | WILLIAM VARNEDOE VERRILLO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1450 MAPLEWOOD DR
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City | MACON
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State | GA
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Zip | 31210-3014
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Country | US
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Telephone | 505-850-7206
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 CAPITOL AVE APT 16
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City | OMAHA
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State | NE
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Zip | 68132-3143
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Country | US
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Telephone | 505-850-7206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122287
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License Number State | GA
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