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General NPI Number Information
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NPI Number | 1740696079
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Entity Type | Individual
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Provider Name | CANDACE LASHAE FLORA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 129 S HIGHWAY 1223
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City | CORBIN
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State | KY
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Zip | 40701-4641
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Country | US
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Telephone | 606-526-9636
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Fax |
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Provider Business Mailing Address
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Address Line | 129 S HIGHWAY 1223
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City | CORBIN
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State | KY
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Zip | 40701-4641
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Country | US
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Telephone | 606-526-9636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9509
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 993
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License Number State | KY
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