Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0401006946 | VA |
NPI | 1225020464 |
---|---|
Provider Name | Dr. Kathleen Susan Kenny |
First Address | Potomac, MD 20854-2347 |
Second Address | Bethesda, MD 20889-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 08/07/2007 |