Provider Demographics
NPI:1225442833
Name:SHAO, KATIE NAGEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:NAGEL
Last Name:SHAO
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 1:600 OLD DUBUQUE RD
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1337
Mailing Address - Country:US
Mailing Address - Phone:319-462-2313
Mailing Address - Fax:
Practice Address - Street 1:600 OLD DUBUQUE RD
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1337
Practice Address - Country:US
Practice Address - Phone:319-462-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice