Provider Demographics
NPI:1881250629
Name:CVACH, KARYN ELEANOR (DMD)
Entity type:Individual
Prefix:DR
First Name:KARYN
Middle Name:ELEANOR
Last Name:CVACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:ELEANOR
Other - Last Name:THREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3611 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3611 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3611
Practice Address - Country:US
Practice Address - Phone:865-356-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014178731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry