Healthcare Provider Details

I. General information

NPI: 1457589517
Provider Name (Legal Business Name): KATHRYN VO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6531 FM 78 SUITE 105
SAN ANTONIO TX
78244-1454
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 210-661-3585
  • Fax:
Mailing address:
  • Phone: 210-928-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number27360
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12726
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: