Provider Demographics
NPI:1407001811
Name:WILL, JOHN T (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:WILL
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 1:211 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5940
Mailing Address - Country:US
Mailing Address - Phone:931-212-3197
Mailing Address - Fax:
Practice Address - Street 1:1470 PANTOPS MOUNTAIN PL STE 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4662
Practice Address - Country:US
Practice Address - Phone:434-817-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91091223D0004X
CA57656122300000X
VA0401429341223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist