Provider Demographics
NPI:1255342499
Name:DODSON, WILLIAM S JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:DODSON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 BREEZEPORT WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3736
Mailing Address - Country:US
Mailing Address - Phone:757-638-4500
Mailing Address - Fax:
Practice Address - Street 1:1510 BREEZEPORT WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3736
Practice Address - Country:US
Practice Address - Phone:757-638-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101271223E0200X
FLDN 148431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics