Provider Demographics
NPI:1861658148
Name:KJOME, ROBERT LOUIS
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:KJOME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 BATHURST RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5828
Mailing Address - Country:US
Mailing Address - Phone:757-467-1198
Mailing Address - Fax:
Practice Address - Street 1:4609 BATHURST RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5828
Practice Address - Country:US
Practice Address - Phone:757-467-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice