Provider Demographics
NPI:1477706737
Name:KONIKOFF PERIODONTICS LTD
Entity Type:Organization
Organization Name:KONIKOFF PERIODONTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-486-8181
Mailing Address - Street 1:477 VIKING DR STE 190
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7354
Mailing Address - Country:US
Mailing Address - Phone:757-486-8181
Mailing Address - Fax:757-463-0148
Practice Address - Street 1:477 VIKING DR STE 190
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty