Provider Demographics
NPI:1104108653
Name:ACKERMAN, KATHRYN INABINETT (RDH)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:INABINETT
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MCKELLAR
Other - Last Name:INABINETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:100 OLD CHEROKEE RD
Mailing Address - Street 2:SUITE F PMB #14
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9316
Mailing Address - Country:US
Mailing Address - Phone:800-276-2398
Mailing Address - Fax:
Practice Address - Street 1:100 OLD CHEROKEE RD
Practice Address - Street 2:SUITE F PMB #14
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9316
Practice Address - Country:US
Practice Address - Phone:800-276-2398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4157124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4157OtherDENTAL HYGIENE LICENSE