Provider Demographics
NPI:1902286453
Name:CROW-GOATES, KATIE E (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:E
Last Name:CROW-GOATES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-0447
Mailing Address - Country:US
Mailing Address - Phone:479-229-3891
Mailing Address - Fax:479-229-2264
Practice Address - Street 1:2533 STATE HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-8831
Practice Address - Country:US
Practice Address - Phone:479-229-3891
Practice Address - Fax:479-229-2264
Is Sole Proprietor?:No
Enumeration Date:2015-05-30
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist