Provider Demographics
NPI:1871681403
Name:RAYFORD, KIMBERLY RODRICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RODRICA
Last Name:RAYFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:R
Other - Last Name:RAYFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:115 ALOYS CIR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5733
Mailing Address - Country:US
Mailing Address - Phone:318-352-0826
Mailing Address - Fax:
Practice Address - Street 1:1297 SHREVEPORT BARKSDALE HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2405
Practice Address - Country:US
Practice Address - Phone:318-865-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1854441Medicaid