Organization
WILLIAM B. PRUDEN, D.M.D., P.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM BAILEY PRUDEN III D.M.D. (OWNER/DENTIST)
(757) 549-8077
Entity
Organization
Contact information
Practice address
1421 KEMPSVILLE RD, SUITE C, CHESAPEAKE, VA 23320-1406
(757) 549-8077
(757) 549-4497
Mailing address
1421 KEMPSVILLE RD, SUITE C, CHESAPEAKE, VA 23320-1406
(757) 549-8077
(757) 549-4497
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008656
VA
Other
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
Enumeration date
02/28/2008
Last updated
02/28/2008
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