Provider Demographics
NPI:1265681308
Name:CONROY, KATHLEEN ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:CONROY
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 1:3704 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2125
Mailing Address - Country:US
Mailing Address - Phone:414-702-6984
Mailing Address - Fax:
Practice Address - Street 1:S63W13660 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-2713
Practice Address - Country:US
Practice Address - Phone:414-425-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6142-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice