Provider Demographics
NPI:1326031626
Name:MORGNTI, KATHERINE R IV (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:MORGNTI
Suffix:IV
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:335 S FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5936
Mailing Address - Country:US
Mailing Address - Phone:703-519-8559
Mailing Address - Fax:
Practice Address - Street 1:110 LUKE AVE SW
Practice Address - Street 2:BOLLING AFB
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032-6400
Practice Address - Country:US
Practice Address - Phone:202-404-4119
Practice Address - Fax:202-404-7366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101941223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered122300000XDental ProvidersDentist