Basic Information
| Provider Information | |||||||||
| NPI: | 1912978248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATTERLIN | ||||||||
| FirstName: | RUSSEL | ||||||||
| MiddleName: | KYLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 423 CORPORAL EVANS ROAD | ||||||||
| Address2: | PRESIDIO OF MONTEREY DENTAL CLINIC | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939440000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312425612 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 423 CORPORAL EVANS ROAD | ||||||||
| Address2: | PRESIDIO OF MONTEREY DENTAL CLINIC | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312425612 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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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 | 1223G0001X | 33071 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.