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Organization
PRINCE WILLIAM PARKWAY DENTAL PC
Active
Organization
PRINCE WILLIAM PARKWAY DENTAL PC
Active
Other names
Pine Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DALE MAYFIELD (PRESIDENT)
(770) 916-5036
Entity
Organization
Contact information
Practice address
2542 PRINCE WILLIAM PKWY STE 120, WOODBRIDGE, VA 22192-4149
(770) 916-9000
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
(770) 916-5036
(678) 285-4760
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
Other
Enumeration date
12/10/2018
Last updated
12/10/2018
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