Provider Demographics
NPI:1750485447
Name:KONZ, KATHERINE JOHANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JOHANNA
Last Name:KONZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 ABBIE CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9713
Mailing Address - Country:US
Mailing Address - Phone:319-341-8368
Mailing Address - Fax:
Practice Address - Street 1:2122 ABBIE CT
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9713
Practice Address - Country:US
Practice Address - Phone:319-341-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry