# PROHEALTH SENIOR SERVICES OF VIRGINIA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104314624
- **Authorized official:** DR. WILLIAM F PROFFITT JR. DDS (OWNER)
- **Authorized official phone:** (844) 700-0088

## Contact information

- **Practice address:** 811 HIGH ST, MARYVILLE, TN 37804-5030
- **Practice address phone:** (844) 700-0088
- **Mailing address:** 8028 HAMPTON LAKE DR, TAMPA, FL 33647-3558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401413088 | VA | Yes |

## Other

- **Enumeration date:** 04/30/2018
- **Last updated:** 04/30/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1649296906 | NPI | — |