Provider Demographics
NPI:1063717734
Name:IGLESIAS, KATTY (DMD)
Entity type:Individual
Prefix:DR
First Name:KATTY
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NW 87TH AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1621
Mailing Address - Country:US
Mailing Address - Phone:305-225-5050
Mailing Address - Fax:305-593-8825
Practice Address - Street 1:2600 NW 87TH AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1621
Practice Address - Country:US
Practice Address - Phone:305-225-5050
Practice Address - Fax:305-593-8825
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice