Provider Demographics
NPI:1215241013
Name:WOLKEN, KATHERINE FAY (DDS)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:FAY
Last Name:WOLKEN
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 1:29 NORTHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1054
Mailing Address - Country:US
Mailing Address - Phone:573-690-0400
Mailing Address - Fax:
Practice Address - Street 1:340 MID RIVERS MALL DR
Practice Address - Street 2:SUITE E
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1581
Practice Address - Country:US
Practice Address - Phone:636-279-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist