Provider Demographics
NPI:1336321942
Name:DETTMANN, DARRYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:
Last Name:DETTMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PATRIOTS COLONY DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1340
Mailing Address - Country:US
Mailing Address - Phone:757-220-5718
Mailing Address - Fax:
Practice Address - Street 1:1501 PATRIOTS COLONY DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1340
Practice Address - Country:US
Practice Address - Phone:757-220-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000288-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist