Provider Demographics
NPI:1528179223
Name:BIGELOW, WILLIAM CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:BIGELOW
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 1:110 MACTANLY PL STE C
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2362
Mailing Address - Country:US
Mailing Address - Phone:540-213-8750
Mailing Address - Fax:540-213-8753
Practice Address - Street 1:110 MACTANLY PL STE C
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2362
Practice Address - Country:US
Practice Address - Phone:540-213-8750
Practice Address - Fax:540-213-8753
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380000741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
393527OtherANTHEM
393527OtherANTHEM
VA190000245Medicare ID - Type Unspecified