Provider Demographics
NPI:1336269927
Name:KOTZ, CATHERINE MCKAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MCKAY
Last Name:KOTZ
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 1:75 MOULTRIEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6633
Mailing Address - Country:US
Mailing Address - Phone:843-216-5504
Mailing Address - Fax:
Practice Address - Street 1:1100 QUEENSBOROUGH BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3626
Practice Address - Country:US
Practice Address - Phone:843-388-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17875122300000X
SC41401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist