Provider Demographics
NPI:1457976995
Name:FAMIGLIO, KATIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:FAMIGLIO
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 1:2205 BELMONT PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1626
Mailing Address - Country:US
Mailing Address - Phone:504-994-5054
Mailing Address - Fax:
Practice Address - Street 1:2209 LAPALCO BLVD STE B
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-6128
Practice Address - Country:US
Practice Address - Phone:504-368-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice