Provider Demographics
NPI:1982628319
Name:STRATTON, KATHLEEN MARY (DDS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:STRATTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 WASHINGTON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7731
Mailing Address - Country:US
Mailing Address - Phone:616-355-7009
Mailing Address - Fax:
Practice Address - Street 1:890 WASHINGTON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7731
Practice Address - Country:US
Practice Address - Phone:616-355-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI132061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice