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General NPI Number Information
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NPI Number | 1871681403
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Entity Type | Individual
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Provider Name | KIMBERLY RODRICA RAYFORD DDS
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 1297 SHREVEPORT BARKSDALE HWY
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City | SHREVEPORT
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State | LA
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Zip | 71105-2405
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Country | US
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Telephone | 318-865-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 115 ALOYS CIR
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City | NATCHITOCHES
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State | LA
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Zip | 71457-5733
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Country | US
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Telephone | 318-352-0826
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5444
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License Number State | LA
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