Provider Demographics
NPI:1073523270
Name:KAVA, RICHARD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:KAVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 HAMILTON BLVD UPPR F
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2551
Mailing Address - Country:US
Mailing Address - Phone:712-258-6169
Mailing Address - Fax:712-258-7053
Practice Address - Street 1:2930 HAMILTON BLVD UPPR F
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2551
Practice Address - Country:US
Practice Address - Phone:712-258-6169
Practice Address - Fax:712-258-7053
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA74321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE42146860400Medicaid
SD07432Medicaid
29401OtherWELLMARK
IA0061713Medicaid
837920OtherGOVERNMENT