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General NPI Number Information
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NPI Number | 1992934418
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Entity Type | Individual
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Provider Name | KATIE KICKERTZ DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 08/07/2023
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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 |
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Provider Business Mailing Address
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Address Line | 5410 SHANNON BELL LN
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City | CHARLOTTE
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State | NC
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Zip | 28277-4425
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Country | US
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Telephone | 815-222-2102
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12949
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 10608
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License Number State | SC
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