Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1033264866 Individual Practitioner Male Practitioner

Dr. David Ira Konicov , DDS

Dentist • Providence, RI

Professional Overview & Biography Verified Profile Summary

Dr. David Konicov, DDS is a registered healthcare professional specializing in Dentist in Providence, RI. Practice services are available at 189 GOVERNOR ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

189 Governor St
Suite 201

Providence, RI 029063124

Telephone 4014211457
Associated Practice Facility / Clinic
🏢 B Allen Flaxman Md Inc Facility NPI 1578737284

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Providence, RI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 2.0 Yrs
State Avg: 8.3 Yrs
Regional Practice Density
66 Specialists

Practicing in Providence, RI (280 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License RI 1907

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
DK01000 (RI)
Commercial Insurance / Payer ID Ri License
1907 (RI)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Donna Cassidy , MSW

Social Worker - Clinical

NPI 1154484988

Master of Social Work

Dr. Jeffrey Shapiro , DMD

Dentist - Periodontics

NPI 1639271554

Doctor of Dental Medicine

Lisa Reidsema , LMHC, MHC, LPC

Counselor - Mental Health

NPI 1649535261

Licensed Mental Health Counselor, MHC, Licensed Professional Counselor

NPI 1659401388

Doctor of Philosophy (Ph.D.)

NPI 1912317652

Licensed Acupuncturist

NPI 1962578617

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 189 GOVERNOR ST, SUITE 201, PROVIDENCE, RI 029063124 (Tel: 4014211457)

📍
Updated Business Mailing Address July 08, 2007

Registered at 189 GOVERNOR ST, SUITE 201, PROVIDENCE, RI 029063124 (Tel: 4014211457)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as DAVID KONICOV, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #1907 in RI)

🟢
Initial NPI Registration & Enumeration January 24, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1033264866
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 24, 2007
Last Update: July 08, 2007
Sole Proprietor: No

Mailing Address

189 Governor St, Suite 201

Providence, RI 029063124

Phone: 4014211457

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.