Provider Demographics
NPI:1215381009
Name:PAULY, KATHERINE LYNN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNN
Last Name:PAULY
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 MILLERSPORT HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2900
Mailing Address - Country:US
Mailing Address - Phone:716-612-3636
Mailing Address - Fax:716-612-3636
Practice Address - Street 1:1321 MILLERSPORT HWY STE 202
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2900
Practice Address - Country:US
Practice Address - Phone:716-612-3636
Practice Address - Fax:716-612-3636
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614851223E0200X
WI10013751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty