Provider Demographics
NPI:1619549540
Name:KATIE L MACKEN DDS LLC
Entity Type:Organization
Organization Name:KATIE L MACKEN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:MACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:980-999-0435
Mailing Address - Street 1:10806 COVE POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6944
Mailing Address - Country:US
Mailing Address - Phone:410-303-6893
Mailing Address - Fax:
Practice Address - Street 1:1550 N DOBYS BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7626
Practice Address - Country:US
Practice Address - Phone:980-999-0435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental