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
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
12/10/2018
Last updated
12/10/2018
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