Provider Demographics
NPI:1811036338
Name:DOPPENBERG, KATHLEEN THUC-ANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:THUC-ANH
Last Name:DOPPENBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:THUC-ANH
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29911 NIGUEL RD UNIT 7777
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-2475
Mailing Address - Country:US
Mailing Address - Phone:949-413-3812
Mailing Address - Fax:
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92637-2752
Practice Address - Country:US
Practice Address - Phone:949-583-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6565122300000X
CA55472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist