Provider Demographics
NPI:1407075039
Name:DEFORD, KATHERINE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:DEFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8410 S 73RD PLZ
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-1513
Mailing Address - Country:US
Mailing Address - Phone:402-592-2219
Mailing Address - Fax:402-597-5111
Practice Address - Street 1:8410 S 73RD PLZ
Practice Address - Street 2:SUITE 104
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-1513
Practice Address - Country:US
Practice Address - Phone:402-592-2219
Practice Address - Fax:402-597-5111
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE63541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025816800Medicaid