Provider Demographics
NPI:1982807285
Name:NORMAN PRILLAMAN DDS LTD
Entity type:Organization
Organization Name:NORMAN PRILLAMAN DDS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:PRILLAMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-385-4499
Mailing Address - Street 1:306 BROOK PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551
Mailing Address - Country:US
Mailing Address - Phone:434-385-4499
Mailing Address - Fax:434-385-7944
Practice Address - Street 1:306 BROOK PARK PLACE
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:434-385-4499
Practice Address - Fax:434-385-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010081001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178723Medicaid