Provider Demographics
NPI:1053411199
Name:DUNCAN, KATHLEEN DENISE (DDS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:DENISE
Last Name:DUNCAN
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 1:11294 COLOMA RD STE C
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4486
Mailing Address - Country:US
Mailing Address - Phone:916-858-0565
Mailing Address - Fax:916-858-0563
Practice Address - Street 1:11294 COLOMA RD STE C
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4486
Practice Address - Country:US
Practice Address - Phone:916-858-0565
Practice Address - Fax:916-858-0563
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93110-01OtherMEDI-CAL DENTAL PROGRAM