Provider Demographics
NPI:1386057537
Name:VILLIER, DONALD RUSSELL JR (DMD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RUSSELL
Last Name:VILLIER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127-0246
Mailing Address - Country:US
Mailing Address - Phone:502-544-1810
Mailing Address - Fax:
Practice Address - Street 1:230 MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127-6080
Practice Address - Country:US
Practice Address - Phone:540-864-5556
Practice Address - Fax:540-864-5558
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401414433OtherVA LICENSE