Provider Demographics
NPI:1366645509
Name:KILDUFF, VIRGINIA S (RDH)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:S
Last Name:KILDUFF
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 KINGS HIGHWAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2520
Mailing Address - Country:US
Mailing Address - Phone:856-428-8822
Mailing Address - Fax:856-428-7157
Practice Address - Street 1:820 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2520
Practice Address - Country:US
Practice Address - Phone:856-428-8822
Practice Address - Fax:856-428-7157
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22H100703100124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist