Provider Demographics
NPI:1285273953
Name:WARNER, KATHERINE GRACE (RDH)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRACE
Last Name:WARNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:GRACE
Other - Last Name:GEARHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:3220 CANTERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2812
Mailing Address - Country:US
Mailing Address - Phone:269-612-2008
Mailing Address - Fax:
Practice Address - Street 1:505 E ALCOTT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-6144
Practice Address - Country:US
Practice Address - Phone:269-349-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017640124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist