Individual
DR. KENNETH LEE TANKERSLEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S AND M.D
Contact information
Practice address
716 DENBIGH BLVD, NEWPORT NEWS, VA 23608-4414
(757) 874-6501
Mailing address
109 THORPES PARISH, WILLIAMSBURG, VA 23185-5119
(757) 345-6979
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01464599
UNITED CONCORDIA
VA
01
—
466101
ANTHEM
VA
05
—
8000590
—
VA
Enumeration date
11/28/2005
Last updated
07/08/2007
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