Provider Demographics
NPI:1669692547
Name:MICHAEL J. KOKORELIS, DMD, INC.
Entity type:Organization
Organization Name:MICHAEL J. KOKORELIS, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOKORELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:757-827-1572
Mailing Address - Street 1:2113 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2575
Mailing Address - Country:US
Mailing Address - Phone:757-827-1572
Mailing Address - Fax:757-827-8895
Practice Address - Street 1:2113 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2575
Practice Address - Country:US
Practice Address - Phone:757-827-1572
Practice Address - Fax:757-827-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty