Provider Demographics
NPI:1659396810
Name:ANDERSON, KATHLEEN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:ANDERSON
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 1:4400 DAUPHINE ST.
Mailing Address - Street 2:BLDG 602, RM. 208
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175
Mailing Address - Country:US
Mailing Address - Phone:504-678-7989
Mailing Address - Fax:504-678-7698
Practice Address - Street 1:4400 DAUPHINE ST.
Practice Address - Street 2:BLDG 602, RM. 208
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70175
Practice Address - Country:US
Practice Address - Phone:504-678-7989
Practice Address - Fax:504-678-7698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist