Provider Demographics
NPI:1356559223
Name:LLEWELLYN, CHARLES S III (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:LLEWELLYN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:933 FIRST COLONIAL RD
Mailing Address - Street 2:#104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-428-2571
Mailing Address - Fax:757-422-4236
Practice Address - Street 1:933 FIRST COLONIAL RD
Practice Address - Street 2:#104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-428-2571
Practice Address - Fax:757-422-4236
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VAVA 62461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice