Provider Demographics
NPI:1356034011
Name:WETTON, KATELYN ELIZABETH JOHNSON (DDS)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:ELIZABETH JOHNSON
Last Name:WETTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:667 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9517
Mailing Address - Country:US
Mailing Address - Phone:906-869-2584
Mailing Address - Fax:
Practice Address - Street 1:3135 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9615
Practice Address - Country:US
Practice Address - Phone:906-226-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016017641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice