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General NPI Number Information
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NPI Number | 1558607150
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Entity Type | Organization
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Legal Business Name | KATHERINE S PAK, DDS PLLC
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 2135 AYRSLEY TOWN BLVD SUITE F
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City | CHARLOTTE
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State | NC
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Zip | 28273-3541
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Country | US
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Telephone | 980-297-7071
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Fax | 980-297-7074
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Provider Business Mailing Address
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Address Line | 2135 AYRSLEY TOWN BLVD SUITE F
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City | CHARLOTTE
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State | NC
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Zip | 28273-3541
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Country | US
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Telephone | 980-297-7071
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Fax | 980-297-7074
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Authorized Official
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Title or Position | MEMBER
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Name | KATHERINE PAK
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Credential | DDS
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Telephone | 980-297-7071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8706
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7592
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License Number State | NC
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