Healthcare Provider Details

I. General information

NPI: 1194984591
Provider Name (Legal Business Name): CHRISTINE I CATALICO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAVARIA DENTAL ACTIVITY CMR 475
APO AE
09036
US

IV. Provider business mailing address

BAVARIA DENTAL ACTIVITY CMR 475
APO AE
09036
US

V. Phone/Fax

Practice location:
  • Phone: 499318897714
  • Fax: 499318897718
Mailing address:
  • Phone: 499318897714
  • Fax: 499318897718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402203831
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: