Provider Demographics
NPI:1356797153
Name:PIET, KATIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:PIET
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:ONE PLACE NOTRE DAME
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:802-748-9357
Mailing Address - Fax:802-748-8770
Practice Address - Street 1:1 NOTRE DAME PL
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2223
Practice Address - Country:US
Practice Address - Phone:802-748-9357
Practice Address - Fax:802-748-8770
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0120686122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program