Provider Demographics
NPI:1033581103
Name:ARKWELL, KATHY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:ARKWELL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 CORNERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-692-3000
Mailing Address - Fax:309-692-4477
Practice Address - Street 1:2425 W CORNERSTONE CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2494
Practice Address - Country:US
Practice Address - Phone:309-692-3000
Practice Address - Fax:309-692-4477
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190168571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics