| William B. Pruden, D.m.d., P.l.c. | |
|
1421 Kempsville Rd Suite C Chesapeake VA 23320-1406 | |
| (757) 549-8077 | |
| (757) 549-4497 |
| Full Name | William B. Pruden, D.m.d., P.l.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1421 Kempsville Rd, Chesapeake, Virginia |
| Authorized Official Name and Position | William Bailey Pruden (OWNER/DENTIST) |
| Authorized Official Contact | 7575498077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| William B. Pruden, D.m.d., P.l.c. 1421 Kempsville Rd Suite C Chesapeake VA 23320-1406 Ph: (757) 549-8077 | William B. Pruden, D.m.d., P.l.c. 1421 Kempsville Rd Suite C Chesapeake VA 23320-1406 Ph: (757) 549-8077 |
| NPI Number | 1780853259 |
|---|---|
| Provider Enumeration Date | 02/28/2008 |
| Last Update Date | 02/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780853259 | NPI | - | NPPES |
| 258032 | Other | VA | BC/BS OF VIRGINIA |
| 2QB260 | Other | VA | BC/BS OF MASSACHUSETTS |
| 7801106 | Medicaid | VA | |
| 322736 | Other | BC/BS | |
| 1574 | Other | VA | DOMINION DENTAL CO. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0401008656 (Virginia) | Primary |
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