MEDICARE: DR. JOHN H UNKEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	0401411824	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	463654	OTHER	VA	ANTHEM BC/BS
3	C06778	OTHER	VA	GROUP PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750316618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H UNKEL DDS

Provider Business Mailing Address
First Line	:	6900 FOREST AVE
Second Line	:	SUITE 110
City	:	RICHMOND
State	:	VA
Zip	:	23230-1701
Country	:	US
Telephone Number	:	804-893-8715
Fax Number	:	804-285-1292

Provider Business Practice Location Address
First Line	:	6900 FOREST AVE
Second Line	:	SUITE 110
City	:	RICHMOND
State	:	VA
Zip	:	23230-1701
Country	:	US
Telephone Number	:	804-893-8715
Fax Number	:	804-285-1292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/25/2015

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