Provider Demographics
NPI:1740696079
Name:FLORA, CANDACE LASHAE (DMD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:LASHAE
Last Name:FLORA
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 1:129 S HIGHWAY 1223
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4641
Mailing Address - Country:US
Mailing Address - Phone:606-526-9636
Mailing Address - Fax:
Practice Address - Street 1:129 S HIGHWAY 1223
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4641
Practice Address - Country:US
Practice Address - Phone:606-526-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9509122300000X
KY9931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100394300Medicaid