Healthcare Provider Details

I. General information

NPI: 1508770520
Provider Name (Legal Business Name): KATHERMAN TONGUE TIE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BONNEVIEW RD
YORK PA
17406-2001
US

IV. Provider business mailing address

3688 PLEASANT VALLEY RD
YORK PA
17406-6606
US

V. Phone/Fax

Practice location:
  • Phone: 814-657-5577
  • Fax:
Mailing address:
  • Phone: 814-657-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KAITLYN KATHERMAN
Title or Position: DENTIST/OWNER
Credential: DMD, FICD, IBCLC
Phone: 814-657-5577