Provider Demographics
NPI:1922451392
Name:LO, KATRINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 NE VANCOUVER MALL DR STE D
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-8179
Mailing Address - Country:US
Mailing Address - Phone:360-892-6555
Mailing Address - Fax:
Practice Address - Street 1:7107 NE VANCOUVER MALL DR STE D
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-8179
Practice Address - Country:US
Practice Address - Phone:360-892-6555
Practice Address - Fax:360-892-4170
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100288122300000X
ORD114141223G0001X
WADE60900883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice