Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9366 | SC |
N | 1223X0400X | Orthodontists | 2017 | SC |
NPI | 1073174025 |
---|---|
Provider Name | Dr. Katherine Alexandra Pischke-Thomas |
First Address | Spartanburg, SC 29307-1415 |
Second Address | Spartanburg, SC 29307-1415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 27/07/2021 |