Provider Demographics
NPI:1215292255
Name:PAUL E. PRILLAMAN, III, DDS, PLC
Entity type:Organization
Organization Name:PAUL E. PRILLAMAN, III, DDS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:PRILLAMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-547-2820
Mailing Address - Street 1:905 BATTLEFIELD BLVD N STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4875
Mailing Address - Country:US
Mailing Address - Phone:757-547-2820
Mailing Address - Fax:757-547-4301
Practice Address - Street 1:905 BATTLEFIELD BLVD N
Practice Address - Street 2:101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4875
Practice Address - Country:US
Practice Address - Phone:757-547-2820
Practice Address - Fax:757-547-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190000572Medicare PIN