Provider Demographics
NPI:1558607150
Name:KATHERINE S PAK, DDS PLLC
Entity Type:Organization
Organization Name:KATHERINE S PAK, DDS PLLC
Other - Org Name:ELAINE R. MCNEIGHT, DDS PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:980-297-7071
Mailing Address - Street 1:2135 AYRSLEY TOWN BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3541
Mailing Address - Country:US
Mailing Address - Phone:980-297-7071
Mailing Address - Fax:980-297-7074
Practice Address - Street 1:2135 AYRSLEY TOWN BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3541
Practice Address - Country:US
Practice Address - Phone:980-297-7071
Practice Address - Fax:980-297-7074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AYRSLEY FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7592122300000X
NC8706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty