Provider Demographics
NPI:1558672733
Name:NORDEEN, KATHERINE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
Last Name:NORDEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:WILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:521 N 11TH ST
Mailing Address - Street 2:PO BOX 980566
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5045
Mailing Address - Country:US
Mailing Address - Phone:804-828-9095
Mailing Address - Fax:
Practice Address - Street 1:521 N 11TH ST
Practice Address - Street 2:ROOM 315
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5045
Practice Address - Country:US
Practice Address - Phone:804-828-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist