Provider Demographics
NPI:1366056558
Name:DICKENS, KATIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 ELM FALL
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-0092
Mailing Address - Country:US
Mailing Address - Phone:252-619-3632
Mailing Address - Fax:
Practice Address - Street 1:104 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3748
Practice Address - Country:US
Practice Address - Phone:832-379-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist