Provider Demographics
NPI:1548378243
Name:KING, CATHERINE POLEMIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:POLEMIS
Last Name:KING
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 1:2531 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4432
Mailing Address - Country:US
Mailing Address - Phone:407-425-0087
Mailing Address - Fax:407-254-4450
Practice Address - Street 1:2531 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4432
Practice Address - Country:US
Practice Address - Phone:407-425-0087
Practice Address - Fax:407-254-4450
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN100820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist