1134142797 NPI number — DR. WILLIAM VINCENT DOUGHERTY III D.D.S.

Table of content: DR. WILLIAM VINCENT DOUGHERTY III D.D.S. (NPI 1134142797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134142797 NPI number — DR. WILLIAM VINCENT DOUGHERTY III D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGHERTY
Provider First Name:
WILLIAM
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134142797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 LITTLE FALLS ST.
Provider Second Line Business Mailing Address:
SUITE 506
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-532-3300
Provider Business Mailing Address Fax Number:
703-532-3302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 LITTLE FALLS ST.
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-532-3300
Provider Business Practice Location Address Fax Number:
703-532-3302
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401007155 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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