| NPI | 1316469653 |
|---|---|
| Former Name | KATELYN MICHELLE KENNEDY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 37083) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2025-01-21 |