Provider Demographics
NPI:1720648835
Name:AMEND, KATELYNN ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ANNE
Last Name:AMEND
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 1:200 DES MOINES ST APT 112
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2070
Mailing Address - Country:US
Mailing Address - Phone:319-239-6412
Mailing Address - Fax:
Practice Address - Street 1:600 E 17TH ST S STE A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-4014
Practice Address - Country:US
Practice Address - Phone:641-792-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-096761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice