Provider Demographics
NPI:1255896940
Name:WEST, KATELYN SCHNEIDER (DMD)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:SCHNEIDER
Last Name:WEST
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1065 JOHNNIE DODDS BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-884-5166
Mailing Address - Fax:803-434-6299
Practice Address - Street 1:1065 JOHNNIE DODDS BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-884-5166
Practice Address - Fax:803-434-6299
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91861223G0001X
SCDGD.91861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice