Individual
DAVID IRA KONICOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
189 GOVERNOR ST, SUITE 201, PROVIDENCE, RI 02906-3124
(401) 421-1457
Mailing address
189 GOVERNOR ST, SUITE 201, PROVIDENCE, RI 02906-3124
(401) 421-1457
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1907
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1907
RI LICENSE
RI
05
—
DK01000
—
RI
Enumeration date
01/24/2007
Last updated
07/08/2007
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