Provider Demographics
NPI:1194217638
Name:MCTIGUE, KATHRYN DAVIS
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DAVIS
Last Name:MCTIGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELAINE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-2741
Mailing Address - Country:US
Mailing Address - Phone:919-663-1774
Mailing Address - Fax:919-663-4400
Practice Address - Street 1:224 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-2741
Practice Address - Country:US
Practice Address - Phone:919-663-1774
Practice Address - Fax:919-663-4400
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist