MEDICARE: DR. JONATHAN ALAN MAHAFFEY DMD

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	1223P0700X	Prosthodontics	DN 10944	FL
2	1223P0700X	Prosthodontics	021865L	PA

General Provider Information

NPI Number	:	1952377574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN ALAN MAHAFFEY DMD

Provider Business Mailing Address
First Line	:	4055 LONGVIEW LNDG
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-1457
Country	:	US
Telephone Number	:	757-903-2877
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 LONGVIEW LNDG
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-1457
Country	:	US
Telephone Number	:	757-903-2877
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	06/18/2014

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