Provider Demographics
NPI:1669775979
Name:INMAN, KATHLEEN NANETTE (RDA, RDH, BS)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:NANETTE
Last Name:INMAN
Suffix:
Gender:F
Credentials:RDA, RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 GEORGE V AVE
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1005
Mailing Address - Country:US
Mailing Address - Phone:810-679-3465
Mailing Address - Fax:
Practice Address - Street 1:245 S RIDGE ST
Practice Address - Street 2:
Practice Address - City:PORT SANILAC
Practice Address - State:MI
Practice Address - Zip Code:48469-9704
Practice Address - Country:US
Practice Address - Phone:810-622-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902003818124Q00000X
MI2903000741126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant