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KATRINA ALT DMD
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1417307067
Individual Registrant: KATRINA ALT DMD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
13395 N MARANA MAIN ST MARANA, AZ 85653-7008 US
Tel: 520-616-6200 Fax: --
Tel: 520-616-6200 Fax: --
Contact information for business:
PO BOX 188 MARANA, AZ 85653-0188 US
Tel: 520-682-4111 Fax: --
Tel: 520-682-4111 Fax: --
Registration Information:
NPI: 1417307067
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | AZ | D009503 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| LICENSE | D009503 | AZ | 01 |
