1477706737 NPI number — KONIKOFF PERIODONTICS LTD

Table of content: CINDERELLA ANN MILLER WILKINS PA (NPI 1346221298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477706737 NPI number — KONIKOFF PERIODONTICS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KONIKOFF PERIODONTICS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477706737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
477 VIKING DR STE 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-7354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-486-8181
Provider Business Mailing Address Fax Number:
757-463-0148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
477 VIKING DR STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-7354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-486-8181
Provider Business Practice Location Address Fax Number:
757-463-0148
Provider Enumeration Date:
10/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
MELODY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
757-486-8181

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)