Provider Demographics
NPI:1275596009
Name:KLONOWSKI, KATHLEEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:L
Last Name:KLONOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:KLONOWSKI
Other - Last Name:MURLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4685 MCLEOD DR E
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2851
Mailing Address - Country:US
Mailing Address - Phone:989-799-5690
Mailing Address - Fax:
Practice Address - Street 1:4685 MCLEOD DR E
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2851
Practice Address - Country:US
Practice Address - Phone:989-799-5690
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist