Provider Demographics
NPI:1184970170
Name:ZOUMBOUKOS, KATHRYN A (DMD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:ZOUMBOUKOS
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 1:6000 W WILLIAM CANNON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1975
Mailing Address - Country:US
Mailing Address - Phone:512-282-0277
Mailing Address - Fax:512-282-7207
Practice Address - Street 1:6000 W WILLIAM CANNON DR STE A200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1977
Practice Address - Country:US
Practice Address - Phone:512-282-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9757122300000X
TX32789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist