Provider Demographics
NPI:1407340276
Name:BRAUER, KATELYN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MARIE
Last Name:BRAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6741 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9164
Mailing Address - Country:US
Mailing Address - Phone:765-418-0665
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR STE 4205
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012956A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty