Provider Demographics
NPI:1952377574
Name:MAHAFFEY, JONATHAN ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALAN
Last Name:MAHAFFEY
Suffix:
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 1:4055 LONGVIEW LNDG
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1457
Mailing Address - Country:US
Mailing Address - Phone:757-903-2877
Mailing Address - Fax:
Practice Address - Street 1:4055 LONGVIEW LNDG
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1457
Practice Address - Country:US
Practice Address - Phone:757-903-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 109441223P0700X
PA021865L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics