Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8099 | NC |
NPI | 1457411167 |
---|---|
Provider Name | Dr. Katrina Chaundani Mattison |
First Address | Mebane, NC 27302 |
Second Address | Prospect Hill, NC 27314-9438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 07/05/2013 |