Provider Demographics
NPI:1700974367
Name:JODRY, KATHRYN GRAHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:GRAHAM
Last Name:JODRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BUCKINGHAM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5850
Mailing Address - Country:US
Mailing Address - Phone:972-235-6752
Mailing Address - Fax:972-235-8688
Practice Address - Street 1:1001 BUCKINGHAM RD
Practice Address - Street 2:STE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5850
Practice Address - Country:US
Practice Address - Phone:972-235-6752
Practice Address - Fax:972-235-8688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist