Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402204467 | VA |
N | 126800000X | Dental Assistant | 195701 | VA |
NPI | 1326393455 |
---|---|
Provider Name | Mrs. Kara Faye Davis |
First Address | Bristol, VA 24202-4013 |
Second Address | Bristol, VA 24202-4013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2012 |
Last Update Date | 15/07/2012 |