Provider Demographics
NPI:1952431454
Name:WINGFIELD, WILLIAM RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:WINGFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:VA
Mailing Address - Zip Code:23401-0310
Mailing Address - Country:US
Mailing Address - Phone:757-787-7718
Mailing Address - Fax:757-787-8804
Practice Address - Street 1:18093 N R NORTH ST
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:VA
Practice Address - Zip Code:23401-0310
Practice Address - Country:US
Practice Address - Phone:757-787-7718
Practice Address - Fax:757-787-8804
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010063941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice