# WILLIAM B. PRUDEN, D.M.D., P.L.C.

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

## Provider details

- **NPI number:** 1780853259
- **Authorized official:** DR. WILLIAM BAILEY PRUDEN III D.M.D. (OWNER/DENTIST)
- **Authorized official phone:** (757) 549-8077

## Contact information

- **Practice address:** 1421 KEMPSVILLE RD, SUITE C, CHESAPEAKE, VA 23320-1406
- **Practice address phone:** (757) 549-8077
- **Practice address fax:** (757) 549-4497
- **Mailing address:** 1421 KEMPSVILLE RD, SUITE C, CHESAPEAKE, VA 23320-1406
- **Mailing address phone:** (757) 549-8077
- **Mailing address fax:** (757) 549-4497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401008656 | VA | Yes |

## Other

- **Enumeration date:** 02/28/2008
- **Last updated:** 02/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1574 | DOMINION DENTAL CO. | VA |
| 01 | — | 258032 | BC/BS OF VIRGINIA | VA |
| 01 | — | 2QB260 | BC/BS OF MASSACHUSETTS | VA |
| 01 | — | 322736 | BC/BS | — |
| 05 | — | 7801106 | — | VA |