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General NPI Number Information
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NPI Number | 1235512559
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Entity Type | Individual
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Provider Name | KATHERINE BOONE D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1218 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1808
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Country | US
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Telephone | 706-860-0518
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Fax |
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Provider Business Mailing Address
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Address Line | 680 CRANE CREEK DR APT 434
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City | AUGUSTA
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State | GA
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Zip | 30907-3075
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015009
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License Number State | GA
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