Provider Demographics
NPI:1568916096
Name:KIN, KATHERINE SUSAN (DDS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUSAN
Last Name:KIN
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 1:24200 SOUTHWEST FWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5985
Mailing Address - Country:US
Mailing Address - Phone:281-232-4446
Mailing Address - Fax:
Practice Address - Street 1:24200 SOUTHWEST FWY STE 202
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5985
Practice Address - Country:US
Practice Address - Phone:281-232-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice