Provider Demographics
NPI:1669512968
Name:SILL, LAURENCE SCOTT
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:SCOTT
Last Name:SILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:L
Other - Middle Name:SCOTT
Other - Last Name:SILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12125 GLEN GARY CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1669
Mailing Address - Country:US
Mailing Address - Phone:804-360-4830
Mailing Address - Fax:
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-282-8712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice