Organization
CD VIRGINIA DENTAL, P.C.
Active
Other names
Konikoff Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
TY V JUSTICE (DIRECTOR, PAYER RELATIONS)
(513) 808-4984
Entity
Organization
Contact information
Practice address
931 PROVIDENCE RD, CHESAPEAKE, VA 23325-4200
(757) 366-0330
(757) 366-0550
Mailing address
9825 KENWOOD RD STE 200, BLUE ASH, OH 45242-6252
(513) 808-4984
(513) 448-0511
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/16/2019
Last updated
08/16/2019
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