Konicov, David Ira

Konicov, David Ira is an individual health care provider with primary practice located at 189 Governor St Suite 201, Providence RI 02906-3124. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Konicov, David Ira can be contacted via phone (401) 421-1457.

Contact Information

Primary practice address
189 Governor St Suite 201 Providence RI 02906-3124
Phone: (401) 421-1457
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 1907 Rhode Island

Profile Details

NPI number 1033264866
LBN Legal business name Konicov, David Ira
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033264866 NPPES
Rhode Island MEDICAID DK01000
Rhode Island Other 1907

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