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General NPI Number Information
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NPI Number | 1194874818
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Entity Type | Individual
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Provider Name | CATHERINE BRIGID MC KINLEY BDENTSC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 8221 FREDERICKSBURG RD SEVILLE OFFICE PARK
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3355
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Country | US
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Telephone | 210-614-3334
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Fax | 210-614-3331
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Provider Business Mailing Address
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Address Line | 9876 DOS CERROS LOOP E
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City | BOERNE
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State | TX
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Zip | 78006-5100
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Country | US
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Telephone | 830-981-8978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 19466
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License Number State | TX
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