Provider Demographics
NPI:1164807962
Name:PECHEK, KATHERINE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:PECHEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HOGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 BONFORTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1601
Mailing Address - Country:US
Mailing Address - Phone:719-544-5340
Mailing Address - Fax:719-583-2205
Practice Address - Street 1:1560 BONFORTE BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1601
Practice Address - Country:US
Practice Address - Phone:719-544-5340
Practice Address - Fax:719-583-2205
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2025961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice