Healthcare Provider Details

I. General information

NPI: 1780910240
Provider Name (Legal Business Name): KATHERINE JONES HOLSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHERINE JONES

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 MCKAY RD
JACKSON MI
49201-9261
US

IV. Provider business mailing address

304 W ANTOINE ST
IRON MOUNTAIN MI
49801-1314
US

V. Phone/Fax

Practice location:
  • Phone: 517-740-5620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902015485
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4877
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: