Provider Demographics
NPI:1255598561
Name:CARSON, KATHERINE R (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:CARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:LINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 GENERAL BOOTH BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-427-0144
Mailing Address - Fax:
Practice Address - Street 1:2020 GENERAL BOOTH BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-427-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014113831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics