Provider Demographics
NPI:1194062034
Name:SOVEREIGN, CATHERINE B (RDH, RD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:B
Last Name:SOVEREIGN
Suffix:
Gender:F
Credentials:RDH, RD
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:B
Other - Last Name:BARELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:5721 GOLIAD ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5407
Mailing Address - Country:US
Mailing Address - Phone:505-345-0091
Mailing Address - Fax:
Practice Address - Street 1:5721 GOLIAD ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5407
Practice Address - Country:US
Practice Address - Phone:505-345-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM568124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist