Provider Demographics
NPI:1730717869
Name:KREH, KATELYN MARIE
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MARIE
Last Name:KREH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N COMMERCE ST APT 405
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3489
Mailing Address - Country:US
Mailing Address - Phone:262-227-6975
Mailing Address - Fax:
Practice Address - Street 1:5600 COORS BLVD NW STE G4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1877
Practice Address - Country:US
Practice Address - Phone:505-431-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD55361223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health