Provider Demographics
NPI:1386486454
Name:KAMBHU, KATHRYN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:KAMBHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1175
Mailing Address - Country:US
Mailing Address - Phone:319-337-7017
Mailing Address - Fax:
Practice Address - Street 1:180 HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1175
Practice Address - Country:US
Practice Address - Phone:319-337-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-102161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice