Provider Demographics
NPI:1144228719
Name:KONIKOFF, ALBERT B (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:B
Last Name:KONIKOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 DARTFORD MEWS
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6160
Mailing Address - Country:US
Mailing Address - Phone:757-486-2796
Mailing Address - Fax:757-463-0148
Practice Address - Street 1:477 VIKING DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7354
Practice Address - Country:US
Practice Address - Phone:757-486-8181
Practice Address - Fax:757-463-0148
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA44451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics