Provider Demographics
NPI:1831256650
Name:KONIKOFF FAMILY DENTISTRY
Entity type:Organization
Organization Name:KONIKOFF FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KONIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-583-1535
Mailing Address - Street 1:7400 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3436
Mailing Address - Country:US
Mailing Address - Phone:757-583-1535
Mailing Address - Fax:757-480-1889
Practice Address - Street 1:7400 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3436
Practice Address - Country:US
Practice Address - Phone:757-583-1535
Practice Address - Fax:757-480-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010048801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty