Provider Demographics
NPI:1013053891
Name:PINS, KATHARINE JOLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:JOLEEN
Last Name:PINS
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 1:100 S 4TH AVENUE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748
Mailing Address - Country:US
Mailing Address - Phone:563-285-5600
Mailing Address - Fax:563-296-5622
Practice Address - Street 1:100 S 4TH AVENUE
Practice Address - Street 2:UNIT 2
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748
Practice Address - Country:US
Practice Address - Phone:563-285-5600
Practice Address - Fax:563-296-5622
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0498063Medicaid