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General NPI Number Information
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NPI Number | 1952377574
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Entity Type | Individual
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Provider Name | JONATHAN ALAN MAHAFFEY DMD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 4055 LONGVIEW LNDG
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1457
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Country | US
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Telephone | 757-903-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 4055 LONGVIEW LNDG
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1457
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Country | US
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Telephone | 757-903-2877
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN 10944
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 021865L
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License Number State | PA
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