Healthcare Provider Details

I. General information

NPI: 1174804280
Provider Name (Legal Business Name): NAHEE WILLIAMS MCDONALD DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841F ROLLING RD
SPRINGFIELD VA
22153-2821
US

IV. Provider business mailing address

7841F ROLLING RD
SPRINGFIELD VA
22153-2821
US

V. Phone/Fax

Practice location:
  • Phone: 703-455-1339
  • Fax:
Mailing address:
  • Phone: 703-455-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401411394
License Number StateVA

VIII. Authorized Official

Name: DR. NAHEE WILLIAMS MCDONALD
Title or Position: PRESIDENT
Credential: DDS
Phone: 703-455-1339