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General NPI Number Information
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NPI Number | 1689985921
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Entity Type | Individual
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Provider Name | KATHLEEN VANVORST INCAVO D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 5757 WOODWAY DR STE 155
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City | HOUSTON
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State | TX
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Zip | 77057-1514
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Country | US
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Telephone | 832-699-7712
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Fax |
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Provider Business Mailing Address
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Address Line | 3913 TENNYSON ST
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City | HOUSTON
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State | TX
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Zip | 77005-2853
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Country | US
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Telephone |
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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 | 35643
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 055950
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License Number State | NY
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