Provider Demographics
NPI:1427365394
Name:HIMDEN, KATHLEEN FRANCES (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:HIMDEN
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 1:10213 N FOXKIRK DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3623
Mailing Address - Country:US
Mailing Address - Phone:262-238-9099
Mailing Address - Fax:
Practice Address - Street 1:6051 W BROWN DEER RD STE 203W
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2263
Practice Address - Country:US
Practice Address - Phone:414-354-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33700600Medicaid