Healthcare Provider Details

I. General information

NPI: 1033373485
Provider Name (Legal Business Name): KATHERINE ROSALIE SCHLOESSER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE ROSALIE RICKARD DMD

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 HAMLIN HWY
LAKE ARIEL PA
18436-9319
US

IV. Provider business mailing address

554 HAMLIN HWY
LAKE ARIEL PA
18436-9319
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-0358
  • Fax: 570-352-3395
Mailing address:
  • Phone: 570-253-0358
  • Fax: 570-352-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS037512
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: