Provider Demographics
NPI:1780896449
Name:MATTHES, KATHI JO (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHI
Middle Name:JO
Last Name:MATTHES
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 1:517 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2258
Mailing Address - Country:US
Mailing Address - Phone:816-524-3734
Mailing Address - Fax:816-524-9211
Practice Address - Street 1:517 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2258
Practice Address - Country:US
Practice Address - Phone:816-524-3734
Practice Address - Fax:816-524-9211
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO160201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice