Provider Demographics
NPI:1477876548
Name:COVINGTON, GINA FONFARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:FONFARA
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 9TH AVENUE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3879
Mailing Address - Country:US
Mailing Address - Phone:828-322-4258
Mailing Address - Fax:
Practice Address - Street 1:360 9TH AVENUE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3879
Practice Address - Country:US
Practice Address - Phone:828-322-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist