Provider Demographics
NPI:1265615033
Name:GREEN NAUGHTON, KATHLEEN C (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:C
Last Name:GREEN NAUGHTON
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 1:5134 N 69TH PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-7001
Mailing Address - Country:US
Mailing Address - Phone:602-499-6933
Mailing Address - Fax:
Practice Address - Street 1:5134 N 69TH PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-7001
Practice Address - Country:US
Practice Address - Phone:602-499-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19365122300000X
AZ5132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist