Provider Demographics
NPI:1336792787
Name:DECKER, MARY CATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY CATHERINE
Middle Name:
Last Name:DECKER
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 1:8002 WATTS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3811
Mailing Address - Country:US
Mailing Address - Phone:608-831-7770
Mailing Address - Fax:
Practice Address - Street 1:8002 WATTS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3811
Practice Address - Country:US
Practice Address - Phone:608-831-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist