MEDICARE: DR. KATHLEEN M. DU LAC DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN17088	FL

General Provider Information

NPI Number	:	1598724296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN M. DU LAC DMD

Provider Business Mailing Address
First Line	:	446 N PINE MEADOW DR
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-2305
Country	:	US
Telephone Number	:	407-340-4922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W LAKE MARY BLVD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3501
Country	:	US
Telephone Number	:	407-328-6411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/24/2011

Similar Medicare Providers

1720050750 — DR. ANNE MCNAMARA DPM
Practice Location Address:

2500 W LAKE MARY BLVD STE 210
LAKE MARY, FL
32746-3501

Practice Phone: 407-956-4123
Practice Fax: 407-671-4155

1629051941 — RYAN C. W. HALL, MD, PA
Practice Location Address:

2500 W LAKE MARY BLVD STE 219
LAKE MARY, FL
32746-3501

Practice Phone: 407-322-8199
Practice Fax: 407-322-8169

1821078866 — EAST COAST HOSPITAL INPATIENT SPECIALISTS PLC
Practice Location Address:

2500 W LAKE MARY BLVD , SUITE 101
LAKE MARY, FL
32746-3501

Practice Phone: 407-936-0976
Practice Fax: 407-936-0977

1699740571 — MARJORIE DIAZ PT
Practice Location Address:

2500 W LAKE MARY BLVD , SUITE 108
LAKE MARY, FL
32746-3501

Practice Phone: 407-516-3459
Practice Fax: 866-378-9982

1821056516 — HASIB IBNERASA M.D.
Practice Location Address:

2500 W LAKE MARY BLVD , SUITE 101
LAKE MARY, FL
32746-3501

Practice Phone: 407-936-0976
Practice Fax: 407-936-0977

1588612592 — MR. ASIF MIRZA
Practice Location Address:

2500 W LAKE MARY BLVD , SUITE 101
LAKE MARY, FL
32746-3501

Practice Phone: 407-936-0976
Practice Fax: 407-936-0977

Directions to “ DR. KATHLEEN M. DU LAC DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.