Provider Demographics
NPI:1306960984
Name:TWYNER COLEY, KATHLEEN D (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:D
Last Name:TWYNER COLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:D
Other - Last Name:TWYNER-COLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:16273 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4889
Mailing Address - Country:US
Mailing Address - Phone:563-343-7870
Mailing Address - Fax:574-387-5822
Practice Address - Street 1:16273 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4889
Practice Address - Country:US
Practice Address - Phone:563-322-7059
Practice Address - Fax:563-328-8936
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011595A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210708Medicaid