Provider Demographics
NPI:1194905356
Name:CATO, KELLEY MARIE (RDH)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:CATO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD CHEROKEE RD
Mailing Address - Street 2:SUITE F, BOX 14
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9316
Mailing Address - Country:US
Mailing Address - Phone:803-808-2304
Mailing Address - Fax:803-808-5642
Practice Address - Street 1:100 OLD CHEROKEE RD
Practice Address - Street 2:SUITE F, BOX 14
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9316
Practice Address - Country:US
Practice Address - Phone:803-808-2304
Practice Address - Fax:803-808-5642
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3377124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist