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General NPI Number Information
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NPI Number | 1366707473
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Entity Type | Individual
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Provider Name | KATHERINE ELIZABETH SO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 310 N DELAWARE ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1887
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Country | US
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Telephone | 317-218-9901
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Fax | 317-947-0689
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Provider Business Mailing Address
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Address Line | 310 N DELAWARE ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1887
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Country | US
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Telephone | 317-218-9901
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Fax | 317-947-0689
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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 | 12011847A
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License Number State | IN
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