Provider Demographics
NPI:1174726608
Name:KATHLEEN R MCDERMOTT DDS MS PC
Entity type:Organization
Organization Name:KATHLEEN R MCDERMOTT DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:281-277-3555
Mailing Address - Street 1:4907 SANDHILL DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5352
Mailing Address - Country:US
Mailing Address - Phone:281-277-3555
Mailing Address - Fax:281-277-3571
Practice Address - Street 1:4907 SANDHILL DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5352
Practice Address - Country:US
Practice Address - Phone:281-277-3555
Practice Address - Fax:281-277-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty