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General NPI Number Information
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NPI Number | 1124013032
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Entity Type | Individual
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Provider Name | ALEX M. KORDIS D.D.S
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 9197 FRANKTOWN RD
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City | FRANKTOWN
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State | VA
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Zip | 23354-2254
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Country | US
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Telephone | 757-442-4819
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Fax |
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Provider Business Mailing Address
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Address Line | 20280 MARKET ST
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City | ONANCOCK
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State | VA
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Zip | 23417-1331
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Country | US
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Telephone | 757-414-0400
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4784
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4825
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0404000062
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License Number State | VA
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