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NPI Code Detail

MEDICARE: DONALD RUSSELL VILLIER JR. DMD

MEDICARE: DONALD RUSSELL VILLIER JR. DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist0401414433VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10401414433OTHERVAVA LICENSE

General Provider Information

NPI Number : 1386057537
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD RUSSELL VILLIER JR. DMD
Provider Business Mailing Address
First Line : PO BOX 246
Second Line :
City : NEW CASTLE
State : VA
Zip : 24127-0246
Country : US
Telephone Number : 502-544-1810
Fax Number :
Provider Business Practice Location Address
First Line : 230 MARKET ST
Second Line :
City : NEW CASTLE
State : VA
Zip : 24127-6080
Country : US
Telephone Number : 540-864-5556
Fax Number : 540-864-5558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2014
Last Update Date : 06/05/2014

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