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General NPI Number Information
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NPI Number | 1467005686
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Entity Type | Individual
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Provider Name | MARY KATHERINE CLEVELAND DMD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 9202 ELAM RD
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City | DALLAS
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State | TX
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Zip | 75217-4151
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Country | US
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Telephone | 888-682-7286
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Fax |
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Provider Business Mailing Address
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Address Line | 7230 MEADOW LAKE AVE
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City | DALLAS
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State | TX
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Zip | 75214-3526
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Country | US
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Telephone | 256-483-6763
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 35234
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License Number State | TX
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