John Leon Kordulak, DDS
Individual provider Active NPI General Practice Dentistry · Vabeach, VA
NPI 1285790873 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285790873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 0401004781 (VA)
- Practice address
- 855 Kempsville Rd
Vabeach, VA 23464 - Phone
- (757) 495-4700
- Fax
- (757) 495-3432
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401004781 | VA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John L. Kordulak | Past | Accepting new patients | |
| The Foleck Center, LTD. | General Practice | Past | Accepting new patients |
| The Foleck Center, LTD. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401004781 | VA | Yes |
Addresses
Primary practice location
855 Kempsville Rd
Vabeach, VA 23464
Mailing address
855 Kempsville Rd
Vabeach, VA 23464
Phone (757) 495-4700
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.