Provider Demographics
NPI:1588890834
Name:LUSE, KATHRYN GRACE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:GRACE
Last Name:LUSE
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 1:3705 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2211
Mailing Address - Country:US
Mailing Address - Phone:972-345-3657
Mailing Address - Fax:
Practice Address - Street 1:4160 HERITAGE TRACE PKWY
Practice Address - Street 2:#408
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5312
Practice Address - Country:US
Practice Address - Phone:817-741-4288
Practice Address - Fax:817-741-2088
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist