Provider Demographics
NPI:1619061637
Name:IKUMA, KATHRYN KYLE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:KYLE
Last Name:IKUMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:KYLE
Other - Last Name:WYNKOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:13 MECHANIC STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019
Mailing Address - Country:US
Mailing Address - Phone:508-966-1522
Mailing Address - Fax:508-966-4464
Practice Address - Street 1:13 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019
Practice Address - Country:US
Practice Address - Phone:508-966-1522
Practice Address - Fax:508-966-4464
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice