William B. Pruden, D.M.D., P.L.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401008656 Issued in VA

Legal business name

WILLIAM B. PRUDEN, D.M.D., P.L.C.

Practice address

1421 Kempsville Rd
Suite C
Chesapeake, VA 23320-1406

Phone

(757) 549-8077

Fax

(757) 549-4497

NPI assigned

Feb 28, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William Bailey Pruden III, D.M.D.

Title

Owner/Dentist

Phone

(757) 549-8077

Specialties & licenses 1

Addresses

Other identifiers 5

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1780853259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 KEMPSVILLE RD",
            "address_2": "SUITE C",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201406",
            "telephone_number": "757-549-8077",
            "fax_number": "757-549-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 KEMPSVILLE RD",
            "address_2": "SUITE C",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201406",
            "telephone_number": "757-549-8077",
            "fax_number": "757-549-4497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM B. PRUDEN, D.M.D., P.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "PRUDEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BAILEY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "757-549-8077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401008656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF VIRGINIA",
            "identifier": "258032",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MASSACHUSETTS",
            "identifier": "2QB260",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801106",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "322736",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOMINION DENTAL CO.",
            "identifier": "1574",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.