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General NPI Number Information
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NPI Number | 1134544075
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Entity Type | Individual
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Provider Name | BRIAN CHRISTOPHER MAHONEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2014
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 102 W BROADDUS AVE STE 200
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City | BOWLING GREEN
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State | VA
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Zip | 22427
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Country | US
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Telephone | 804-632-1030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | NEW CANTON
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State | VA
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Zip | 23123-0220
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Country | US
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Telephone | 434-581-4073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60551302
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DR60468203
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License Number State | WA
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