Provider Demographics
NPI:1518088731
Name:DEFRIES, KAMRA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMRA
Middle Name:M
Last Name:DEFRIES
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 1:1 CROWN DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2510
Mailing Address - Country:US
Mailing Address - Phone:660-665-9869
Mailing Address - Fax:660-627-0681
Practice Address - Street 1:1 CROWN DR
Practice Address - Street 2:SUITE 204
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2510
Practice Address - Country:US
Practice Address - Phone:660-665-9869
Practice Address - Fax:660-627-0681
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040142361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice