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General NPI Number Information
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NPI Number | 1063570968
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Entity Type | Organization
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Legal Business Name | KONIKOFF DENTAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2100 LYNNHAVEN PKWY SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1492
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Country | US
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Telephone | 757-416-1800
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Fax | 757-416-9276
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Provider Business Mailing Address
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Address Line | 2100 LYNNHAVEN PKWY SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1492
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Country | US
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Telephone | 757-416-1800
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Fax | 757-416-9276
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Authorized Official
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Title or Position | VP INSURANCE PLAN MANAGEMENT
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Name | MIKE COLE
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Credential |
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Telephone | 727-424-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | VA
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