Provider Demographics
NPI:1619064243
Name:CHARLES E KATH DDS PA
Entity Type:Organization
Organization Name:CHARLES E KATH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-645-0449
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5109
Mailing Address - Country:US
Mailing Address - Phone:651-645-0449
Mailing Address - Fax:651-647-4951
Practice Address - Street 1:1021 BANDANA BLVD E
Practice Address - Street 2:SUITE 100
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5109
Practice Address - Country:US
Practice Address - Phone:651-645-0449
Practice Address - Fax:651-647-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty