Provider Demographics
NPI:1689961385
Name:VORWALD, KATHRYN (MD, DDS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:VORWALD
Suffix:
Gender:F
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HARDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5917
Mailing Address - Country:US
Mailing Address - Phone:863-665-8878
Mailing Address - Fax:863-665-1096
Practice Address - Street 1:2150 HARDEN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5917
Practice Address - Country:US
Practice Address - Phone:863-665-8878
Practice Address - Fax:863-665-1096
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131781204E00000X
FLDN274981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery