Provider Demographics
NPI:1124599758
Name:POE, KATHERINE (RDH)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:POE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 LINDEN LOOP
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4498
Mailing Address - Country:US
Mailing Address - Phone:337-349-4527
Mailing Address - Fax:
Practice Address - Street 1:12400 W HIGHWAY 71 STE 320
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6504
Practice Address - Country:US
Practice Address - Phone:512-271-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002024460124Q00000X
TX21143124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist