Provider Demographics
NPI:1538965629
Name:DAGES, KIERRA (DMD)
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:DAGES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N EUGENE ST APT 125
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-4960
Mailing Address - Country:US
Mailing Address - Phone:859-816-0393
Mailing Address - Fax:
Practice Address - Street 1:510 NICHOLAS RD STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-3404
Practice Address - Country:US
Practice Address - Phone:336-387-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC14346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program