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NPI Code Detail

MEDICARE: KATRINA CO DMD

MEDICARE: KATRINA CO DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN22808FL
2122300000XDentistDS041871PA
31223G0001XGeneral Practice DentistryDN122218GA

General Provider Information

NPI Number : 1598206443
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRINA CO DMD
Provider Business Mailing Address
First Line : 4030 WINDER HWY
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-3021
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4030 WINDER HWY
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-3021
Country : US
Telephone Number : 678-960-3440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2017
Last Update Date : 03/09/2021

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Directions to “ KATRINA CO DMD” Practice Location

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