Healthcare Provider Details

I. General information

NPI: 1619938966
Provider Name (Legal Business Name): MICHAEL JOHN KAURICH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR VA MEDICAL CENTER
HAMPTON VA
23667-0001
US

IV. Provider business mailing address

100 EMANCIPATION DR VA MEDICAL CENTER
HAMPTON VA
23667-0001
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax: 757-728-3138
Mailing address:
  • Phone: 757-722-9961
  • Fax: 757-728-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401008053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: