Healthcare Provider Details

I. General information

NPI: 1831578244
Provider Name (Legal Business Name): KATHRYN PRESTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W THOMAS RD
PHOENIX AZ
85013-4414
US

IV. Provider business mailing address

124 W THOMAS RD STE 320
PHOENIX AZ
85013-4415
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0500
  • Fax: 602-933-4320
Mailing address:
  • Phone: 602-406-3560
  • Fax: 602-406-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD011206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: