Provider Demographics
NPI:1265452478
Name:SUDIKOFF, KATHRYN JANE (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JANE
Last Name:SUDIKOFF
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 1:1315 EAST BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5789
Mailing Address - Country:US
Mailing Address - Phone:704-632-9922
Mailing Address - Fax:704-632-9933
Practice Address - Street 1:1315 EAST BLVD STE 260
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5789
Practice Address - Country:US
Practice Address - Phone:704-632-9922
Practice Address - Fax:866-864-3970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3542122300000X
NC94731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist