Provider Demographics
NPI:1881704617
Name:ORR, KATHERINE EYNON (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:EYNON
Last Name:ORR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JESSICA
Other - Last Name:EYNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5430 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1553
Mailing Address - Country:US
Mailing Address - Phone:317-598-8500
Mailing Address - Fax:317-598-8503
Practice Address - Street 1:5430 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1553
Practice Address - Country:US
Practice Address - Phone:317-598-8500
Practice Address - Fax:317-598-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010259A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200467340AMedicaid