Provider Demographics
NPI:1326393455
Name:DAVIS, KARA FAYE (CD,A, RDH)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:FAYE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CD,A, RDH
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:FAYE
Other - Last Name:GOBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDA, RDH
Mailing Address - Street 1:15325 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-4013
Mailing Address - Country:US
Mailing Address - Phone:276-781-6116
Mailing Address - Fax:276-591-5959
Practice Address - Street 1:15325 LEE HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-4013
Practice Address - Country:US
Practice Address - Phone:276-781-6116
Practice Address - Fax:276-591-5959
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402204467124Q00000X
VA195701126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant