Kathryn Koury, D.M.D.
Individual provider Active NPI Dentist · Mansfield, PA
NPI 1083840912 · NPPES record last updated Jun 5, 2009
Key facts
- NPI
- 1083840912
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS0378885 (PA)
- Practice address
- 17 N Main St
#1
Mansfield, PA 16933-1432 - Phone
- (570) 662-2886
- NPI assigned
- Jun 5, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS0378885 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R M Stager DMD & J R Coole DMD Stager & Coole Dentistry | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS0378885 | PA | Yes |
Addresses
Primary practice location
17 N Main St
#1
Mansfield, PA 16933-1432
Mailing address
17 N Main St
#1
Mansfield, PA 16933-1432
Phone (570) 662-2886
Other providers in Mansfield, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.