Individual
JUNE KELLER VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
241 CHARLES H DIMMOCK PKWY, SUITE 2, COLONIAL HEIGHTS, VA 23834-2915
(804) 520-0699
(804) 520-1765
Mailing address
241 CHARLES H DIMMOCK PKWY, SUITE 2, COLONIAL HEIGHTS, VA 23834-2915
(804) 520-0699
(804) 520-1765
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
VA7324
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070781
ANTHEM BCBS
VA
01
—
615937
UNITED CONCORDIA
VA
Enumeration date
08/30/2005
Last updated
08/10/2007
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