Provider Demographics
NPI:1912978248
Name:CATTERLIN, RUSSEL KYLE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:KYLE
Last Name:CATTERLIN
Suffix:JR
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 1:423 CORPORAL EVANS ROAD
Mailing Address - Street 2:PRESIDIO OF MONTEREY DENTAL CLINIC
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-0000
Mailing Address - Country:US
Mailing Address - Phone:831-242-5612
Mailing Address - Fax:
Practice Address - Street 1:423 CORPORAL EVANS ROAD
Practice Address - Street 2:PRESIDIO OF MONTEREY DENTAL CLINIC
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944
Practice Address - Country:US
Practice Address - Phone:831-242-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice