Provider Demographics
NPI:1609874361
Name:MANSELL-GLOWACKY, KATHI MARIE
Entity Type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:MARIE
Last Name:MANSELL-GLOWACKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHI
Other - Middle Name:MARIE
Other - Last Name:MANSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9370 E. CALLE DE LAS BRISAS
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4335
Mailing Address - Country:US
Mailing Address - Phone:480-502-1843
Mailing Address - Fax:
Practice Address - Street 1:7595 E. MCDONALD DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6004
Practice Address - Country:US
Practice Address - Phone:480-948-1255
Practice Address - Fax:480-951-5844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice