Prince William Parkway Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRINCE WILLIAM PARKWAY DENTAL PC

Practice address

2542 Prince William Pkwy Ste 120
Woodbridge, VA 22192-4149

Phone

(770) 916-9000

NPI assigned

Dec 10, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dale Mayfield

Title

President

Phone

(770) 916-5036

Specialties & licenses 5

Addresses

Other names 1

• Pine Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1154892677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407",
            "telephone_number": "770-916-5036",
            "fax_number": "678-285-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2542 PRINCE WILLIAM PKWY STE 120",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924149",
            "telephone_number": "770-916-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE WILLIAM PARKWAY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-916-5036"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prince William Pediatrics and Adolescent Center
• Prince William Plastic Surgery and Spa Services Company, LLC
• Prince William Speech and Hearing Center, Inc
• Claria Lynna Prior
• Priority Medical Transport LLC

• General Practice Dentistry in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.