Provider Demographics
NPI:1043542145
Name:SUGAR, KATIE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MARIE
Last Name:SUGAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W CHANNEL ISLANDS BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2106
Mailing Address - Country:US
Mailing Address - Phone:805-985-0300
Mailing Address - Fax:
Practice Address - Street 1:475 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:STE 203
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2106
Practice Address - Country:US
Practice Address - Phone:805-985-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA60110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program