Provider Demographics
NPI:1467583039
Name:SUCKLING, KATRINA W (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:W
Last Name:SUCKLING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 1ST ST NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-8204
Mailing Address - Country:US
Mailing Address - Phone:330-745-0502
Mailing Address - Fax:330-745-6020
Practice Address - Street 1:180 1ST ST NW
Practice Address - Street 2:SUITE 2
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-8204
Practice Address - Country:US
Practice Address - Phone:330-745-0502
Practice Address - Fax:330-745-6020
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice