Provider Demographics
NPI:1386412955
Name:KING, DANIELLE NAOMI (RDH)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NAOMI
Last Name:KING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:NAOMI
Other - Last Name:GIRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:3814 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4202
Mailing Address - Country:US
Mailing Address - Phone:540-676-0251
Mailing Address - Fax:
Practice Address - Street 1:1240 3RD ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4612
Practice Address - Country:US
Practice Address - Phone:540-344-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207031124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist