Provider Demographics
NPI:1639202658
Name:CARDENAS, KATHRYN ANN HACKENBERG (DMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN HACKENBERG
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NATURE WALK PKWY UNIT 105
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5065
Mailing Address - Country:US
Mailing Address - Phone:904-497-4343
Mailing Address - Fax:904-484-7563
Practice Address - Street 1:109 NATURE WALK PKWY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5059
Practice Address - Country:US
Practice Address - Phone:904-497-4343
Practice Address - Fax:904-484-7563
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 165551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice