# CHARLES S LLEWELLYN III DDS PC

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

## Provider details

- **NPI number:** 1962610873
- **Authorized official:** DR. CHARLES SILAS LLEWELLYN III DDS (PRESIDENT)
- **Authorized official phone:** (757) 428-2571

## Contact information

- **Practice address:** 1729 WILDWOOD DR, \#104, VIRGINIA BEACH, VA 23454-3176
- **Practice address phone:** (757) 428-2571
- **Practice address fax:** (757) 502-7229
- **Mailing address:** 1729 WILDWOOD DR, \#104, VIRGINIA BEACH, VA 23454-3176
- **Mailing address phone:** (757) 428-2571
- **Mailing address fax:** (757) 502-7229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | VA6246 | VA | Yes |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 02/16/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 274488 | ANTHEM | VA |