Select Plan Provider Directory - Dominion Dental Services, Inc.

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SELECT PLAN 1 DENTIST DIRECTORY Dentists listed are under contract as of 10/1/12 Last Name First Name Fac ID Dental Office Name Office Address City ST ZIP Discipline County Dandashi Moutaz 050699 Katsur Dental & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Pedodontist Westmoreland Hertzler L Gregory 050699 Katsur Dental & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland Kelly Derek 050699 Katsur Dental & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland Kier Gregory 050699 Katsur Dental & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Periodontist Westmoreland Monti Richard 050699 Katsur Dental & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland Vince Thomas 001536 Thomas S. Vince, D.M.D. & Associates 985 Towne Square Drive, Suite 100 Greensburg PA 15601 General Provider Westmoreland Purvis Kenneth 001853 Kenneth G. Purvis D.D.S. Ltd. 1010 Jefferson Street Latrobe PA 15650 Orthodontist Westmoreland Matthews Bruce 001624 Bruce A. Matthews, D.M.D., M.D.S. 123 W. Main Street, Suite 1 Ligonier PA 15658 Orthodontist Westmoreland Purvis Kenneth 001856 Kenneth G. Purvis, D.D.S. Ltd. 112 South Walnut Ligonier PA 15658 Orthodontist Westmoreland Adams William 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Affolter John 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Alagirisamy Kiruthika 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Carozza Roselyn 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Cohen Ira 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Dahar Nicholas 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Damich Louis 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Ghaffari Catherine 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Ghajarnia M. Reza 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Gillen Steve 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Iszkula Steven 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Katsur James 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Khurana Leena 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Kier Calvin 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland King David 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Kolla Siva 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Lewis Howell 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Miller Van 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Pryor Leroy 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Rinchuse Dara 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland Schmidt Alan 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Smiga Ingrid 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Stein Mark 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Tinnemeyer Anjuli 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Zalakar Frank 000989 Katsur Dental & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland Dandashi Moutaz 050693 Katsur Dental & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Pedodontist Westmoreland Hertzler L Gregory 050693 Katsur Dental & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland Kelly Derek 050693 Katsur Dental & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland Kier Gregory 050693 Katsur Dental & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Periodontist Westmoreland Monti Richard 050693 Katsur Dental & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland Kreashko Robert 002570 Kreashko Orthodontics 2755 Leechburg Rd. Lower Burrell PA 15068 Orthodontist Westmoreland Seitz Raymond 002330 Raymond C. Seitz, D.M.D. 2797 Leechburg Road Lower Burrell PA 15068 General Provider Westmoreland Al Rasheed Manuela 001898 Manuela Al Rasheed, D.M.D. 828 W. Main Street Mount Pleasant PA 15666 General Provider Westmoreland Santora Donald 001608 Mt Pleasant Dental Associates PC 770 Route 819 South, P.O. Box 954 Mount Pleasant PA 15666 General Provider Westmoreland Loyacona Gerald 001840 Gerald Loyacona, D.M.D. 4771 Old William Penn Hwy. Murrysville PA 15668 Orthodontist Westmoreland Balasubramaniam Ravi 001492 Laurel Highlands Family Dentistry 4057 Old William Penn Murrysville PA 15668 General Provider Westmoreland Matthews Bruce 001625 Bruce A. Matthews, D.M.D., M.D.S. 1061 Main Street, Banco Bus Park, Suite 2CI North Huntingdon PA 15642 Orthodontist Westmoreland Babameto Blendi 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 Oral Surgeon York Desai Jagruti 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 General Provider York Kaur Kamaljit 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 General Provider York Kuleva Juliana 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 General Provider York Popernack John 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 General Provider York Talati Ankit 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 General Provider York Withanachchi Janatha 051062 Aspen Dental 409 Eisenhower Dr Hanover PA 17331 Endodontist York Babameto Blendi 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 Oral Surgeon York Botros Samuel 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York Chandalada Agastayya 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York Hu Yu Hui 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York Pham Thuy 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York Tran Joshua 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York Williams Christopher 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York Withanachchi Janatha 037962 Aspen Dental Associates of NE PA PC 2803 Concord Rd York PA 17402 Endodontist York Babameto Blendi 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 Oral Surgeon York Botros Samuel 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Chandalada Agastayya 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Chaudhry Ahmad 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Hamati Isam 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 42 1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY Dentists listed are under contract as of 10/1/12 Last Name First Name Fac ID Dental Office Name Office Address City ST ZIP Discipline County Hu Yu Hui 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Pham Thuy 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Tran Joshua 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Williams Christopher 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York Withanachchi Janatha 033834 Aspen Dental Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 Endodontist York Byrnside Valerie 051075 Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack Goodove Scott 051075 Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack Harris Christopher 051075 Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack Kotler Lawrence 000224 Lawrence M. Kotler, D.D.S., MS. 3543 W. Braddock Rd., E-1 Alexandria VA 22302 Endodontist Alexandria City Phan Phuong 002274 Phuong Phan D.MD PC 1225 Martha Custis Drive, #C-6 Alexandria VA 22302 General Provider Alexandria City Alayssami Mazin 000144 Bright Now Dental 5249 Duke Street, Suite 210 Alexandria VA 22304 General Provider Alexandria City Khattak Farida 000144 Bright Now Dental 5249 Duke Street, Suite 210 Alexandria VA 22304 General Provider Alexandria City Selenou-Tema Alain 000144 Bright Now Dental 5249 Duke Street, Suite 210 Alexandria VA 22304 General Provider Alexandria City Morgan David 080801 David M Morgan DDS MD PLC 101 S Whiting St, Suite 106 Alexandria VA 22304 Oral Surgeon Alexandria City Meza Fernando 037720 Fernando J. Meza, DMD, PLLC 4660 Kenmore Ave, 700 Alexandria VA 22304 Endodontist Alexandria City Russo Revand Jessica 037720 Fernando J. Meza, DMD, PLLC 4660 Kenmore Ave, 700 Alexandria VA 22304 Endodontist Alexandria City Tsui Nathan 000239 Nathan Tsui, D.D.S. 5249 Duke St., Suite 10 Alexandria VA 22304 General Provider Alexandria City Kwon Thomas 000342 Thomas S. Kwon, D.D.S. 4701 Kenmore Ave., Suite 122 Alexandria VA 22304 General Provider Alexandria City Traboulsi Georges 097168 Alexandria Smile Dentistry Specialists 5234 Dawes Ave Alexandria VA 22311 Periodontist Alexandria City Tolson Ronald 000215 Ronald E Tolson DDS 5246 Dawes Ave Alexandria VA 22311 General Provider Alexandria City Kermanshi Shiva 050340 Alexandria Dental Care PLLC 715 Pendleton St Alexandria VA 22314 Orthodontist Alexandria City Solemaninejad Homan 050340 Alexandria Dental Care PLLC 715 Pendleton St Alexandria VA 22314 General Provider Alexandria City Gasper Ronald 001660 Ronald S. Gasper, D.D.S., Ltd. 1454 Duke St, Suite 200 Alexandria VA 22314 Orthodontist Alexandria City Huynh Thuylinh 050343 Arlington Center For Dentistry Orthodontics 1050 N Highland St, 300-N Arlington VA 22201 Orthodontist Arlington Asher Kevin 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington Colosi Ryan 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington Gichana Roselyne 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington Lan Steve 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington Nguyen Phuong 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington Park Nam 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington Son Joseph 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Endodontist Arlington Shojaei Mariah 037689 Arlington Cosmetic Dental Group 1731 Clarendon Blvd Arlington VA 22201 Endodontist Arlington * Economides Mino 000939 Mino Economides, D.D.S. 1301 N. Highland Street Arlington VA 22201 General Provider Arlington * Lebo Carl 000233 Carl G Lebo DDS PC 3801 N. Fairfax Dr., Suite 72 Arlington VA 22203 General Provider Arlington Zadeh David 001664 Zadeh Dental Office 611 S. Carlin Springs Road, Suite 408 Arlington VA 22204 General Provider Arlington Patterson Travis 002109 Drs. Whiston, Patterson & Corcoran 2501 N. Glebe Road, Suite 203 Arlington VA 22207 Oral Surgeon Arlington Saleh Fadi 050933 Fadi Saleh DDS LLC 1911 N Fort Myer Drive, Suite 101 Arlington VA 22209 Orthodontist Arlington Mogharbel Tarek 037711 Mira Dental Care 1901 N Moore St, Suite 501 Arlington VA 22209 General Provider Arlington Boyce Darrell 002606 Darrell L. Boyce, D.D.S.,P.C. 1711 Parkview Dr. Chesapeake VA 23320 General Provider Chesapeake City * Abdelwahab Tamer 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Abdelwahab Tamer 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Ansari Uzma 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Ansari Uzma 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Berrada Sanae 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Berrada Sanae 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Bozman Jenny 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Bozman Jenny 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Chawla Seema 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Chawla Seema 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Dobson Roberta 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Dobson Roberta 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Dobson, III Joseph 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Dobson, III Joseph 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Elosta Wael 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Elosta Wael 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Field Marcus 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Field Marcus 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Field Sheila 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Field Sheila 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Gioffre Mollie 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Gioffre Mollie 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Hoek Meredith 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Hoek Meredith 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Jones Daniel 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Jones Daniel 050722 Konikoff Dental Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City * Konikoff David 068512 Konikoff Dental Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 43 1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.
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Select Plan Provider Directory - Dominion Dental Services, Inc.

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