Provider Demographics
NPI:1942707773
Name:PASSMAN, KATIE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PASSMAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6 W 77TH ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5125
Mailing Address - Country:US
Mailing Address - Phone:917-921-7584
Mailing Address - Fax:
Practice Address - Street 1:29 COOPER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3818
Practice Address - Country:US
Practice Address - Phone:212-567-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0581751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics