Provider Demographics
NPI:1225342017
Name:STANTON, KATHLEEN
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3511
Mailing Address - Country:US
Mailing Address - Phone:336-903-9300
Mailing Address - Fax:336-903-0464
Practice Address - Street 1:1915 W PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3511
Practice Address - Country:US
Practice Address - Phone:336-903-9300
Practice Address - Fax:336-903-0464
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice