Provider Demographics
NPI:1548334071
Name:DAHLKE, WILLIAM O JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:O
Last Name:DAHLKE
Suffix:JR
Gender:M
Credentials:DMD
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2560 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1468
Mailing Address - Country:US
Mailing Address - Phone:804-741-2226
Mailing Address - Fax:
Practice Address - Street 1:2560 GASKINS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1468
Practice Address - Country:US
Practice Address - Phone:804-741-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014146111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510130Medicaid