Provider Demographics
NPI:1992226484
Name:THATCH, KATRINA ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:ANNE
Last Name:THATCH
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 1:2244 MILLCREST TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4397
Mailing Address - Country:US
Mailing Address - Phone:704-315-7859
Mailing Address - Fax:
Practice Address - Street 1:3610 BOULEVARD STE A
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1329
Practice Address - Country:US
Practice Address - Phone:804-526-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000296122300000X
VA0401416005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist