Provider Demographics
NPI:1164951075
Name:MARCELO, KATHLEEN RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN RAE
Middle Name:
Last Name:MARCELO
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 1:1011B PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6413
Mailing Address - Country:US
Mailing Address - Phone:707-253-9235
Mailing Address - Fax:
Practice Address - Street 1:1011B PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6413
Practice Address - Country:US
Practice Address - Phone:707-253-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1027201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice