Provider Demographics
NPI:1386643955
Name:RADTKE, KATHRYN ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANN
Last Name:RADTKE
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 1:2720 COUNCIL TREE AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6330
Mailing Address - Country:US
Mailing Address - Phone:970-673-7321
Mailing Address - Fax:970-472-0440
Practice Address - Street 1:120 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2031
Practice Address - Country:US
Practice Address - Phone:970-416-5331
Practice Address - Fax:970-472-0440
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist