Provider Demographics
NPI:1235288259
Name:MCFADDEN, KATRINA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:L
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:MCFADDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5600 NORTHGATE ROAD
Mailing Address - Street 2:STE 103
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049
Mailing Address - Country:US
Mailing Address - Phone:817-326-5717
Mailing Address - Fax:817-326-5714
Practice Address - Street 1:5600 N GATE RD STE 103
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-3119
Practice Address - Country:US
Practice Address - Phone:817-326-5717
Practice Address - Fax:817-326-5714
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009483101Medicaid