Individual provider Active NPI

Wesley P Kandare, D.D.S.

  • General Practice Dentistry
  • Virginia Beach, VA
National Provider Identifier
1538249073
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401411450 Issued in VA
Practice address
2100 Lynnhaven Pkwy
Suite #100
Virginia Beach, VA 23456-1492
Phone
(757) 416-1400
Fax
(757) 416-9276
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401411450 VA Primary

Addresses

Primary practice location

2100 Lynnhaven Pkwy
Suite #100
Virginia Beach, VA 23456-1492

Mailing address

2100 Lynnhaven Pkwy
Suite #100
Virginia Beach, VA 23456-1492
Phone (757) 416-1400

Other identifiers 2

IdentifierTypeStateIssuer
019711OtherVAANTHEM ID
816276OtherVAUNITED CONCORDIA ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160505001913 VA Order and Referring Only - DentistPractitioner - Dentist 1850690280

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0401411450VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Konikoff Dental Associates, Inc. General Practice Past Accepting new patients
Konikoff Dental Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538249073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 LYNNHAVEN PKWY",
            "address_2": "SUITE #100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234561492",
            "telephone_number": "757-416-1400",
            "fax_number": "757-416-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 LYNNHAVEN PKWY",
            "address_2": "SUITE #100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234561492",
            "telephone_number": "757-416-1400",
            "fax_number": "757-416-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDARE",
        "first_name": "WESLEY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401411450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ID",
            "identifier": "019711",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID",
            "identifier": "816276",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.