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General NPI Number Information
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NPI Number | 1821788936
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Entity Type | Organization
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Legal Business Name | KATIE KICKERTZ DDS MS PLLC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 6842 CARNEGIE BLVD STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28211-3500
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Country | US
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Telephone | 980-423-1272
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Fax | 980-423-1273
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Provider Business Mailing Address
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Address Line | 6842 CARNEGIE BLVD STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28211-3500
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Country | US
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Telephone | 980-423-1272
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Fax | 980-423-1273
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | KATIE R KICKERTZ
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Credential | DDS, MS
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Telephone | 815-222-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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