Provider Demographics
NPI:1649277385
Name:GARRY, KATHLEEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:GARRY
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 1:101 LEXINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2423
Mailing Address - Country:US
Mailing Address - Phone:952-758-4741
Mailing Address - Fax:952-758-4740
Practice Address - Street 1:101 LEXINGTON AVE S
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2423
Practice Address - Country:US
Practice Address - Phone:952-758-4741
Practice Address - Fax:952-758-4740
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice