Provider Demographics
NPI:1902952021
Name:WILLIAM CARVAJAL DDS MD INC
Entity Type:Organization
Organization Name:WILLIAM CARVAJAL DDS MD INC
Other - Org Name:CENTRAL VIRGINIA ORAL AND FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:434-832-8040
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012338991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty