Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 043727-0 | NY |
NPI | 1144240714 |
---|---|
Provider Name | Dr. Kathleen M Frost |
First Address | Islip, NY 11751-3222 |
Second Address | Islip, NY 11751-3222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |