Basic Information
| Provider Information | |||||||||
| NPI: | 1598025249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATCHEN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | SEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 55TH ST. | ||||||||
| Address2: | LUTHERAN MEDICAL CENTER STATION 3-03 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186306808 | ||||||||
| FaxNumber: | 7186308894 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 55TH ST | ||||||||
| Address2: | LUTHERAN MEDICAL CENTER - STATION 3-03 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112202508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186306808 | ||||||||
| FaxNumber: | 7186308894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2012 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 057362 | NY | N | Dental Providers | Dentist | 1223P0221X | 057362 | NY | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.