Provider Demographics
NPI:1033510813
Name:HETRICK, KATHRYN ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE
Last Name:HETRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CRAWFORD CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9475
Mailing Address - Country:US
Mailing Address - Phone:913-593-6990
Mailing Address - Fax:
Practice Address - Street 1:1008 BIG OAK CT STE C
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6566
Practice Address - Country:US
Practice Address - Phone:919-266-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057496-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist