Provider Demographics
NPI:1962411827
Name:FLAITZ, CATHERINE MARY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:FLAITZ
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:13065 E. 17TH AVE, ROOM 130J
Mailing Address - Street 2:MAIL STOP F844
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2664
Mailing Address - Country:US
Mailing Address - Phone:303-724-6983
Mailing Address - Fax:303-724-6986
Practice Address - Street 1:13065 E. 17TH AVE, ROOM 130J
Practice Address - Street 2:MAIL STOP F844
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:303-724-6983
Practice Address - Fax:303-724-6986
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179511223P0106X
OH30-0243631223P0106X, 1223P0221X
CODEN.001053711223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89773BOtherBLUE CROSS BLUE SHIELD
OH0119665Medicaid
TX111084301Medicaid
OH0119665Medicaid
TX111084301Medicaid