Provider Demographics
NPI:1780881649
Name:VONNAHME, GWINN A K (DMD)
Entity type:Individual
Prefix:DR
First Name:GWINN
Middle Name:A K
Last Name:VONNAHME
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 1:5998 PLEASANT COLONY CT. SUITE 23
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014
Mailing Address - Country:US
Mailing Address - Phone:502-890-2035
Mailing Address - Fax:
Practice Address - Street 1:5998 PLEASANT COLONY CT. SUITE 23
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-890-2035
Practice Address - Fax:502-890-2037
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY85251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice