Provider Demographics
NPI:1083763551
Name:JENDRASIK SAVITSKY, KATHRYN DAWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:DAWN
Last Name:JENDRASIK SAVITSKY
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 1:15022 CROOKED BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7950
Mailing Address - Country:US
Mailing Address - Phone:704-583-6363
Mailing Address - Fax:704-540-8900
Practice Address - Street 1:15825 JOHN J DELANEY DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3146
Practice Address - Country:US
Practice Address - Phone:704-540-2800
Practice Address - Fax:704-540-8900
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice