Provider Demographics
NPI:1427247402
Name:HIDI, KATHERINE FRY (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FRY
Last Name:HIDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:LYNN
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3065 AKERS MILL RD SE STE 225
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3124
Mailing Address - Country:US
Mailing Address - Phone:205-901-4585
Mailing Address - Fax:
Practice Address - Street 1:3065 AKERS MILL RD SE STE 225
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3124
Practice Address - Country:US
Practice Address - Phone:678-990-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54731223E0200X
GA137021223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics