Provider Demographics
NPI:1750493193
Name:CARVAJAL, WILLIAM (DDS, MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CARVAJAL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ARCHWAY CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2890
Mailing Address - Country:US
Mailing Address - Phone:434-832-8040
Mailing Address - Fax:434-832-8041
Practice Address - Street 1:101 ARCHWAY CT
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2890
Practice Address - Country:US
Practice Address - Phone:434-832-8040
Practice Address - Fax:434-832-8041
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380000811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9179586OtherDORAL DENTAL
VA010176743Medicaid
VA462917OtherANTHEM