Provider Demographics
NPI:1215552286
Name:DAVIS, AKIA ROCHE' (DDS)
Entity Type:Individual
Prefix:
First Name:AKIA
Middle Name:ROCHE'
Last Name:DAVIS
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 1:2960 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4153
Mailing Address - Country:US
Mailing Address - Phone:985-641-7971
Mailing Address - Fax:985-641-5182
Practice Address - Street 1:2960 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4153
Practice Address - Country:US
Practice Address - Phone:985-641-7971
Practice Address - Fax:985-641-5182
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7097OtherDENTISTRY