Provider Demographics
NPI:1255328233
Name:MUNN, KATHARINE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:M
Last Name:MUNN
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 1:104 WHALON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7128
Mailing Address - Country:US
Mailing Address - Phone:978-342-4280
Mailing Address - Fax:978-343-4593
Practice Address - Street 1:104 WHALON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7128
Practice Address - Country:US
Practice Address - Phone:978-342-4280
Practice Address - Fax:978-343-4593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20031OtherSTATE LICENSE NUMBER