Provider Demographics
NPI:1487719449
Name:FERNALD, WILLIAM PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:FERNALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 DARRELL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4500
Mailing Address - Country:US
Mailing Address - Phone:804-897-0625
Mailing Address - Fax:
Practice Address - Street 1:5303 PLAZA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-7331
Practice Address - Country:US
Practice Address - Phone:804-458-5047
Practice Address - Fax:804-458-0113
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice