Provider Demographics
NPI:1679778070
Name:WALLENT, CATHELEEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHELEEN
Middle Name:E
Last Name:WALLENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHELEEN
Other - Middle Name:E
Other - Last Name:ALLENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:380 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5638
Mailing Address - Country:US
Mailing Address - Phone:978-686-8500
Mailing Address - Fax:978-686-4032
Practice Address - Street 1:380 SUMMER ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5638
Practice Address - Country:US
Practice Address - Phone:978-686-8500
Practice Address - Fax:978-686-4032
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist