Provider Demographics
NPI:1457349649
Name:IYONMAHAN, KARLA (DDS)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:IYONMAHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:A
Other - Last Name:TASSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:825 MERRIMON AVE STE C
Mailing Address - Street 2:SUITE 355
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2467
Mailing Address - Country:US
Mailing Address - Phone:704-737-8143
Mailing Address - Fax:
Practice Address - Street 1:MARINE CORPS BASE - CAMP LEJEUNE
Practice Address - Street 2:460 BLDG JULIAN C. SMITH BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-451-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice