Provider Demographics
NPI:1497820369
Name:ROBINSON, KATERINA AMELIA (DDS)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:AMELIA
Last Name:ROBINSON
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 1:1315 US HIGHWAY 2 W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3413
Mailing Address - Country:US
Mailing Address - Phone:406-890-6364
Mailing Address - Fax:406-890-6198
Practice Address - Street 1:1315 US HIGHWAY 2 W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3413
Practice Address - Country:US
Practice Address - Phone:406-890-6364
Practice Address - Fax:406-890-6198
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87921223G0001X
MT7755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7170774Medicaid