Provider Demographics
NPI:1578686044
Name:SMALLWOOD, WILLIAM
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21251 DUBOIS CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4903
Mailing Address - Country:US
Mailing Address - Phone:703-729-9464
Mailing Address - Fax:703-729-1227
Practice Address - Street 1:21251 DUBOIS CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4903
Practice Address - Country:US
Practice Address - Phone:703-729-9464
Practice Address - Fax:703-729-1227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist