Provider Demographics
NPI:1790033777
Name:BULLWINKEL, KATHRYN STROUD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:STROUD
Last Name:BULLWINKEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:THAMA
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:405 W 5TH NORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6515
Mailing Address - Country:US
Mailing Address - Phone:843-821-6433
Mailing Address - Fax:843-821-6432
Practice Address - Street 1:405 W 5TH NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6515
Practice Address - Country:US
Practice Address - Phone:843-821-6433
Practice Address - Fax:843-821-6432
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028771122300000X
SC83601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8360OtherDENTAL SPECIALTY LICENSE