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NPI Code Detail

MEDICARE: MRS. KATHLEEN NANETTE INMAN RDA, RDH, BS

MEDICARE: MRS. KATHLEEN NANETTE INMAN RDA, RDH, BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist2902003818MI
2126800000XDental Assistant2903000741MI

General Provider Information

NPI Number : 1669775979
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN NANETTE INMAN RDA, RDH, BS
Provider Business Mailing Address
First Line : 248 GEORGE V AVE
Second Line :
City : CROSWELL
State : MI
Zip : 48422-1005
Country : US
Telephone Number : 810-679-3465
Fax Number :
Provider Business Practice Location Address
First Line : 245 S RIDGE ST
Second Line :
City : PORT SANILAC
State : MI
Zip : 48469-9704
Country : US
Telephone Number : 810-622-8230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2010
Last Update Date : 12/08/2010

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