Provider Demographics
NPI:1093963761
Name:JOHN L. KORDULAK
Entity Type:Organization
Organization Name:JOHN L. KORDULAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KORDULAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-495-4700
Mailing Address - Street 1:855 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2708
Mailing Address - Country:US
Mailing Address - Phone:757-495-4700
Mailing Address - Fax:757-495-3432
Practice Address - Street 1:855 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2708
Practice Address - Country:US
Practice Address - Phone:757-495-4700
Practice Address - Fax:757-495-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA47811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty