Provider Demographics
NPI:1073611422
Name:FORD, CATHY ZOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:ZOE
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 ELK HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8616
Mailing Address - Country:US
Mailing Address - Phone:540-989-5588
Mailing Address - Fax:540-484-1121
Practice Address - Street 1:490 S MAIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151
Practice Address - Country:US
Practice Address - Phone:540-483-5241
Practice Address - Fax:540-484-1121
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7802749Medicaid
VA7802749Medicaid