Provider Demographics
NPI:1073779005
Name:THOKEY KLCO, KATHERINE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANN
Last Name:THOKEY KLCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3150
Mailing Address - Country:US
Mailing Address - Phone:440-428-9568
Mailing Address - Fax:440-428-5667
Practice Address - Street 1:24 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3150
Practice Address - Country:US
Practice Address - Phone:440-428-9568
Practice Address - Fax:440-428-5667
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice