Provider Demographics
NPI:1417601501
Name:KATRINA SUCKLING DDS LLC
Entity Type:Organization
Organization Name:KATRINA SUCKLING DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCKLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-745-0502
Mailing Address - Street 1:3963 S CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5611
Mailing Address - Country:US
Mailing Address - Phone:330-745-0502
Mailing Address - Fax:
Practice Address - Street 1:3963 S CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5611
Practice Address - Country:US
Practice Address - Phone:330-745-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental