NPIMap

Organization Active NPI

Charles S Llewellyn III DDS PC

  • General Practice Dentistry
  • Virginia Beach, VA
National Provider Identifier
1962610873
Registry record updated Feb 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
VA6246 Issued in VA
Legal business name
CHARLES S LLEWELLYN III DDS PC
Practice address
1729 Wildwood Dr
#104
Virginia Beach, VA 23454-3176
Phone
(757) 428-2571
Fax
(757) 502-7229
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2016

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

Authorized official

Name
Dr. Charles Silas Llewellyn III, DDSNPI 1356559223
Title
President
Phone
(757) 428-2571

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X VA6246 VA Primary

Addresses

Primary practice location

1729 Wildwood Dr
#104
Virginia Beach, VA 23454-3176

Mailing address

1729 Wildwood Dr
#104
Virginia Beach, VA 23454-3176
Phone (757) 428-2571

Other identifiers 1

IdentifierTypeStateIssuer
274488OtherVAANTHEM

National Provider Directory

National Provider Directory
Tax ID family
Melvin E Cruser III DDS14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1962610873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1729 WILDWOOD DR",
            "address_2": "#104",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543176",
            "telephone_number": "757-428-2571",
            "fax_number": "757-502-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 WILDWOOD DR",
            "address_2": "#104",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543176",
            "telephone_number": "757-428-2571",
            "fax_number": "757-502-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES S LLEWELLYN III DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "LLEWELLYN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "SILAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-428-2571",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "VA6246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "274488",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.