Provider Demographics
NPI:1780052274
Name:STAUB, KATIE JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JEAN
Last Name:STAUB
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 1:11810 PARKLAWN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2528
Mailing Address - Country:US
Mailing Address - Phone:301-881-6170
Mailing Address - Fax:
Practice Address - Street 1:11810 PARKLAWN DR STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2528
Practice Address - Country:US
Practice Address - Phone:301-881-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist