Provider Demographics
NPI:1639550684
Name:DIGGS, KATELYN KAY (DDS)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:KAY
Last Name:DIGGS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:KAY
Other - Last Name:DIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1547 S HIGGINS AVE # 103
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4226
Mailing Address - Country:US
Mailing Address - Phone:406-543-8591
Mailing Address - Fax:
Practice Address - Street 1:1547 S HIGGINS AVE # 103
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4226
Practice Address - Country:US
Practice Address - Phone:406-543-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13536122300000X
MT135771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist