Provider Demographics
NPI:1386780666
Name:EISIN, KATHLEEN MARIE (DDS, MS,PLLC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:EISIN
Suffix:
Gender:F
Credentials:DDS, MS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 CROSSINGS DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7889
Mailing Address - Country:US
Mailing Address - Phone:616-656-0100
Mailing Address - Fax:616-656-0400
Practice Address - Street 1:6677 CROSSINGS DRIVE SE
Practice Address - Street 2:SUITE #3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-656-0100
Practice Address - Fax:616-656-0400
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010187651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics