Provider Demographics
NPI:1528405735
Name:BUMGARDNER, KATHERINE BLAIR (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BLAIR
Last Name:BUMGARDNER
Suffix:
Gender:F
Credentials:DMD, MSD
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Mailing Address - Street 1:8101 E US HIGHWAY 36 STE A
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8082
Mailing Address - Country:US
Mailing Address - Phone:317-561-0090
Mailing Address - Fax:317-272-6994
Practice Address - Street 1:8101 E US HIGHWAY 36 STE A
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8082
Practice Address - Country:US
Practice Address - Phone:317-561-0090
Practice Address - Fax:317-272-6994
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN12012042A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry