Provider Demographics
NPI:1942289707
Name:VANI, KATHLEEN P (DDS PLLC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:P
Last Name:VANI
Suffix:
Gender:F
Credentials:DDS PLLC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:P
Other - Last Name:VANI-MATWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:52133 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3529
Mailing Address - Country:US
Mailing Address - Phone:586-731-4320
Mailing Address - Fax:
Practice Address - Street 1:52133 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3529
Practice Address - Country:US
Practice Address - Phone:586-731-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice