Provider Demographics
NPI:1447599766
Name:KATNIK, RICHARD DALE (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:KATNIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1101
Mailing Address - Country:US
Mailing Address - Phone:858-569-9651
Mailing Address - Fax:858-576-1884
Practice Address - Street 1:7319 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1101
Practice Address - Country:US
Practice Address - Phone:858-569-9651
Practice Address - Fax:858-576-1884
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice