Healthcare Provider Details

I. General information

NPI: 1730717869
Provider Name (Legal Business Name): DR. KATELYN MARIE KREH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 COORS BLVD NW STE G4
ALBUQUERQUE NM
87120-1877
US

IV. Provider business mailing address

1902 N COMMERCE ST APT 405
MILWAUKEE WI
53212-3489
US

V. Phone/Fax

Practice location:
  • Phone: 505-431-9740
  • Fax:
Mailing address:
  • Phone: 262-227-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDD5536
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: