Healthcare Provider Details

I. General information

NPI: 1659429041
Provider Name (Legal Business Name): JOHN C DOSWELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 FOREST AVE SUITE D
RICHMOND VA
23229-6850
US

IV. Provider business mailing address

513 FOREST AVE SUITE D
RICHMOND VA
23229-6850
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-8839
  • Fax: 804-285-8836
Mailing address:
  • Phone: 804-285-8839
  • Fax: 804-285-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401005483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: