Provider Demographics
NPI:1245724285
Name:ARMISTEAD, NATHANIEL LEMASTER IV (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:LEMASTER
Last Name:ARMISTEAD
Suffix:IV
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 1:607 ARLIE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2623
Mailing Address - Country:US
Mailing Address - Phone:804-467-9657
Mailing Address - Fax:
Practice Address - Street 1:3603 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221
Practice Address - Country:US
Practice Address - Phone:804-912-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014160631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice