# CHILDREN'S DENTISTRY OF CHARLOTTESVILLE, P.C.

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

## Provider details

- **NPI number:** 1265813042
- **Authorized official:** DR. JOHN WILL DDS (SHAREHOLDER)
- **Authorized official phone:** (434) 817-1817

## Contact information

- **Practice address:** 1470 PANTOPS MOUNTAIN PL, CHARLOTTESVILLE, VA 22911-4600
- **Practice address phone:** (434) 817-1817
- **Practice address fax:** (434) 817-1819
- **Mailing address:** 1470 PANTOPS MOUNTAIN PL, CHARLOTTESVILLE, VA 22911-4600
- **Mailing address phone:** (434) 817-1817
- **Mailing address fax:** (434) 817-1819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401412570 | VA | — |
| 122300000X | Dentist | 0401413819 | VA | — |
| 122300000X | Dentist | 0401414088 | VA | Yes |
| 1223D0004X | Dental Anesthesiology | 0401412934 | VA | — |
| 1223D0004X | Dental Anesthesiology | 0401413770 | VA | — |
| 1223P0221X | Pediatric Dentistry | 0401410463 | VA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 753148626 | VA | — |

## Other

- **Enumeration date:** 06/17/2015
- **Last updated:** 06/17/2015