Provider Demographics
NPI:1073174025
Name:PISCHKE-THOMAS, KATHERINE ALEXANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ALEXANDRA
Last Name:PISCHKE-THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1415
Mailing Address - Country:US
Mailing Address - Phone:864-579-7700
Mailing Address - Fax:864-579-7703
Practice Address - Street 1:2455 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1415
Practice Address - Country:US
Practice Address - Phone:864-579-7700
Practice Address - Fax:864-579-7703
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20171223X0400X
SC9366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics