Provider Demographics
NPI:1700920170
Name:TKATCH, STAS I (DDS)
Entity Type:Individual
Prefix:DR
First Name:STAS
Middle Name:I
Last Name:TKATCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3930
Mailing Address - Country:US
Mailing Address - Phone:336-887-3212
Mailing Address - Fax:336-887-3312
Practice Address - Street 1:700 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3930
Practice Address - Country:US
Practice Address - Phone:336-887-3212
Practice Address - Fax:336-887-3312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice