Provider Demographics
NPI:1871659102
Name:HUIZING, KATRINA L (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:L
Last Name:HUIZING
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:L
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:1425 NE FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3026
Mailing Address - Country:US
Mailing Address - Phone:360-377-3844
Mailing Address - Fax:360-377-2148
Practice Address - Street 1:1425 NE FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3026
Practice Address - Country:US
Practice Address - Phone:360-377-3844
Practice Address - Fax:360-377-2148
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3172HAOtherREGENCE INSURANCE
WA5040571Medicaid
PA001409621OtherUNITED CONCORDIA INSURANC