Provider Demographics
NPI:1043570260
Name:FENLON, KATELYN KRISTINE MODJESKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:KRISTINE MODJESKI
Last Name:FENLON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATELYN
Other - Middle Name:KRISTINE
Other - Last Name:MODJESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10434 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1325
Mailing Address - Country:US
Mailing Address - Phone:608-692-7087
Mailing Address - Fax:
Practice Address - Street 1:13014 N SAGUARO BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3966
Practice Address - Country:US
Practice Address - Phone:480-836-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist