Provider Demographics
NPI:1558437988
Name:VICTOR, KATHY LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:VICTOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:CEJMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:117 S WARREN
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-796-3292
Mailing Address - Fax:231-796-3398
Practice Address - Street 1:117 S WARREN
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-796-3292
Practice Address - Fax:231-796-3398
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist