Provider Demographics
NPI:1629564547
Name:KATIE L. NEIDIG DDS, LLC
Entity Type:Organization
Organization Name:KATIE L. NEIDIG DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEIDIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-667-2429
Mailing Address - Street 1:420 E MAIN ST # 37
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:KS
Mailing Address - Zip Code:67108-9459
Mailing Address - Country:US
Mailing Address - Phone:316-667-2429
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:KS
Practice Address - Zip Code:67108-9459
Practice Address - Country:US
Practice Address - Phone:316-667-2429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental