Provider Demographics
NPI:1881708014
Name:POWELL, WILLIAM OSCAR (JR)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:OSCAR
Last Name:POWELL
Suffix:
Gender:M
Credentials:JR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4701 RANDOLPH RD
Mailing Address - Street 2:STE 205
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2257
Mailing Address - Country:US
Mailing Address - Phone:301-230-2216
Mailing Address - Fax:301-230-2217
Practice Address - Street 1:4701 RANDOLPH RD
Practice Address - Street 2:STE 205
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2257
Practice Address - Country:US
Practice Address - Phone:301-230-2216
Practice Address - Fax:301-230-2217
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD043611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice