Healthcare Provider Details

I. General information

NPI: 1649071895
Provider Name (Legal Business Name): JOSHUA KONIKOFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date: 07/10/2026
Reactivation Date: 07/16/2026

III. Provider practice location address

2105 PRINCESS ANNE RD STE 108
VIRGINIA BEACH VA
23456-4164
US

IV. Provider business mailing address

2105 PRINCESS ANNE RD STE 108
VIRGINIA BEACH VA
23456-4164
US

V. Phone/Fax

Practice location:
  • Phone: 757-516-4977
  • Fax: 757-517-0266
Mailing address:
  • Phone: 757-516-4977
  • Fax: 757-517-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: