Provider Demographics
NPI:1992243075
Name:AVANESYAN, KATHERINE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:AVANESYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SKILLESTAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3501 ROSS AVE
Mailing Address - Street 2:APARTMENT 4057
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5449
Mailing Address - Country:US
Mailing Address - Phone:704-708-4478
Mailing Address - Fax:
Practice Address - Street 1:3501 ROSS AVE
Practice Address - Street 2:APARTMENT 4057
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5449
Practice Address - Country:US
Practice Address - Phone:704-708-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist