Provider Demographics
NPI:1336372184
Name:KOCOS, KATHRYN RUTH (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RUTH
Last Name:KOCOS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:RUTH
Other - Last Name:LUTZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13706 W BELL RD
Mailing Address - Street 2:STE 2
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85314
Mailing Address - Country:US
Mailing Address - Phone:623-584-9910
Mailing Address - Fax:623-584-9940
Practice Address - Street 1:2025 N PEBBLECREEK PKWY
Practice Address - Street 2:SUITE A-11
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395
Practice Address - Country:US
Practice Address - Phone:623-214-9979
Practice Address - Fax:623-935-0774
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH5360124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist