Provider Demographics
NPI:1396126959
Name:DYER, KATIE P (DMD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:P
Last Name:DYER
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 1:3120 CYNTH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-4585
Mailing Address - Country:US
Mailing Address - Phone:706-897-8342
Mailing Address - Fax:706-745-9622
Practice Address - Street 1:3120 CYNTH CREEK RD
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-4585
Practice Address - Country:US
Practice Address - Phone:706-897-8342
Practice Address - Fax:706-745-9622
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist