MEDICARE: DR. WILLIAM PAUL FERNALD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401006955	VA

General Provider Information

NPI Number	:	1487719449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM PAUL FERNALD DDS

Provider Business Mailing Address
First Line	:	1424 DARRELL DR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-4500
Country	:	US
Telephone Number	:	804-897-0625
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 PLAZA DR
Second Line	:	SUITE 103
City	:	HOPEWELL
State	:	VA
Zip	:	23860-7331
Country	:	US
Telephone Number	:	804-458-5047
Fax Number	:	804-458-0113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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