Healthcare Provider Details

I. General information

NPI: 1205875770
Provider Name (Legal Business Name): DONALD DUVALL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N PARHAM RD
RICHMOND VA
23294-4412
US

IV. Provider business mailing address

2821 N PARHAM RD
RICHMOND VA
23294-4412
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-7824
  • Fax: 804-270-6654
Mailing address:
  • Phone: 804-270-7824
  • Fax: 804-270-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401004757
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: