Provider Demographics
NPI:1891362307
Name:VERRILLO, WILLIAM VARNEDOE (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VARNEDOE
Last Name:VERRILLO
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 1:4804 CAPITOL AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3143
Mailing Address - Country:US
Mailing Address - Phone:505-850-7206
Mailing Address - Fax:
Practice Address - Street 1:1450 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-3014
Practice Address - Country:US
Practice Address - Phone:505-850-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist