Provider Demographics
NPI:1457691917
Name:KITTS, CONNIE (DDS)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:KITTS
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 1:4807 HERMITAGE RD STE 101
Mailing Address - Street 2:P.O. BOX 15188
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3335
Mailing Address - Country:US
Mailing Address - Phone:804-266-8547
Mailing Address - Fax:804-264-8103
Practice Address - Street 1:4807 HERMITAGE RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3335
Practice Address - Country:US
Practice Address - Phone:804-266-8547
Practice Address - Fax:804-264-8103
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist