Provider Demographics
NPI:1417362641
Name:EDDENS, KATIE RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:RYAN
Last Name:EDDENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:JANE
Other - Last Name:RYAN EDDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3501 TERRACE STREET
Mailing Address - Street 2:SUITE 3189
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261
Mailing Address - Country:US
Mailing Address - Phone:412-648-9100
Mailing Address - Fax:412-383-7862
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:SUITE 3189
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261
Practice Address - Country:US
Practice Address - Phone:412-648-9100
Practice Address - Fax:412-383-7862
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist