Healthcare Provider Details

I. General information

NPI: 1831909415
Provider Name (Legal Business Name): KAI ALEXANDER STANDIFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 JEFFRESS RD
MILLS RIVER NC
28759-3865
US

IV. Provider business mailing address

14 LEIGHTON CT
SIMPSONVILLE SC
29680-7049
US

V. Phone/Fax

Practice location:
  • Phone: 828-501-9453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: