Provider Demographics
NPI:1932844222
Name:FOX, KATHLEEN FLOWERS (RDH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FLOWERS
Last Name:FOX
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2109 ARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1010
Mailing Address - Country:US
Mailing Address - Phone:301-788-6677
Mailing Address - Fax:
Practice Address - Street 1:2109 ARRINGTON RD
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1010
Practice Address - Country:US
Practice Address - Phone:301-788-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5014124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist