Healthcare Provider Details

I. General information

NPI: 1013358373
Provider Name (Legal Business Name): KATHLEEN BAUM DONLEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 STONE BLUFF LN
ALVATON KY
42122-9721
US

IV. Provider business mailing address

395 STONE BLUFF LN
ALVATON KY
42122-9721
US

V. Phone/Fax

Practice location:
  • Phone: 270-746-9110
  • Fax:
Mailing address:
  • Phone: 270-746-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7091
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: