Provider Demographics
NPI:1255772885
Name:PUTNEY, KATHRYN GIBBONS (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:GIBBONS
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:DEANE
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 WOOTEN BLVD SW
Mailing Address - Street 2:BLDG B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8628
Mailing Address - Country:US
Mailing Address - Phone:252-237-8812
Mailing Address - Fax:
Practice Address - Street 1:2801 WOOTEN BLVD SW
Practice Address - Street 2:BLDG B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8628
Practice Address - Country:US
Practice Address - Phone:252-237-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist