Provider Demographics
NPI:1164536678
Name:BARLOW, KATHLEEN LOUISE (DMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:BARLOW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MURRAY
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:16020 PIDDLIN POND LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1531
Mailing Address - Country:US
Mailing Address - Phone:813-625-3530
Mailing Address - Fax:813-349-7761
Practice Address - Street 1:14254 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4414
Practice Address - Country:US
Practice Address - Phone:813-349-7737
Practice Address - Fax:813-349-7761
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075500100Medicaid