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General NPI Number Information
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NPI Number | 1104602135
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Entity Type | Individual
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Provider Name | NICKOLAS LAWRENCE KOENIG DDS
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Gender | Male
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 11601 ROBIOUS RD STE 130B
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-5605
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Country | US
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Telephone | 804-378-7681
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Fax |
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Provider Business Mailing Address
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Address Line | 11601 ROBIOUS RD STE 130B
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-5605
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Country | US
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Telephone | 804-378-7681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 37198
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License Number State | TX
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