Provider Demographics
NPI:1316908460
Name:FEIST, KIM LIVEZEY (RDH)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LIVEZEY
Last Name:FEIST
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11808 LENOX LA
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-590-6928
Mailing Address - Fax:
Practice Address - Street 1:3299 WOODBURN RD
Practice Address - Street 2:STE 440 DR J DOUGLAS WOODDELL
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-698-9698
Practice Address - Fax:703-849-0935
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402001879124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist