Provider Demographics
NPI:1609393990
Name:SOVAK, KAYLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:SOVAK
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 1:1101 S COLUMBIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4055
Mailing Address - Country:US
Mailing Address - Phone:701-795-1101
Mailing Address - Fax:
Practice Address - Street 1:1101 S COLUMBIA RD STE B
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4055
Practice Address - Country:US
Practice Address - Phone:701-795-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND23151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice