Provider Demographics
NPI:1811209059
Name:ANTONY, KATHRYN ALEJANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ALEJANDRA
Last Name:ANTONY
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 1:11648 HAMPTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2949
Mailing Address - Country:US
Mailing Address - Phone:352-256-8950
Mailing Address - Fax:
Practice Address - Street 1:13820 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5427
Practice Address - Country:US
Practice Address - Phone:904-260-7700
Practice Address - Fax:904-260-7733
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-03
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice