Provider Demographics
NPI:1154726115
Name:WILLIAMSBURG FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:WILLIAMSBURG FAMILY DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-345-5500
Mailing Address - Street 1:213 BULIFANTS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5733
Mailing Address - Country:US
Mailing Address - Phone:757-345-5500
Mailing Address - Fax:
Practice Address - Street 1:213 BULIFANTS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5733
Practice Address - Country:US
Practice Address - Phone:757-345-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410542122300000X
VA0401411453122300000X
VA0401413221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401411453Medicaid
VA0401413221Medicaid
VA0401410542Medicaid