Provider Demographics
NPI:1861485393
Name:VERNON, JUNE KELLER (DDS)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:KELLER
Last Name:VERNON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CHARLES H DIMMOCK PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2915
Mailing Address - Country:US
Mailing Address - Phone:804-520-0699
Mailing Address - Fax:804-520-1765
Practice Address - Street 1:241 CHARLES H DIMMOCK PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2915
Practice Address - Country:US
Practice Address - Phone:804-520-0699
Practice Address - Fax:804-520-1765
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA73241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA615937OtherUNITED CONCORDIA
VA070781OtherANTHEM BCBS