Healthcare Provider Details

I. General information

NPI: 1144228719
Provider Name (Legal Business Name): ALBERT B. KONIKOFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 VIKING DR
VIRGINIA BEACH VA
23452-7354
US

IV. Provider business mailing address

1018 DARTFORD MEWS
VIRGINIA BEACH VA
23452-6160
US

V. Phone/Fax

Practice location:
  • Phone: 757-486-8181
  • Fax: 757-463-0148
Mailing address:
  • Phone: 757-486-2796
  • Fax: 757-463-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4445
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: