Provider Demographics
NPI:1992862601
Name:KEY, KATHLEEN KELLY (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KELLY
Last Name:KEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:KEY
Other - Last Name:FRERICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3938 CEDAR GROVE PKWY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1403
Mailing Address - Country:US
Mailing Address - Phone:651-452-9660
Mailing Address - Fax:651-406-8544
Practice Address - Street 1:3938 CEDAR GROVE PKWY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1403
Practice Address - Country:US
Practice Address - Phone:651-452-9660
Practice Address - Fax:651-406-8544
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice