Katie Kickertz DDS Ms PLLC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

KATIE KICKERTZ DDS MS PLLC

Practice address

6842 Carnegie Blvd Ste 200
Charlotte, NC 28211-3500

Phone

(980) 423-1272

Fax

(980) 423-1273

NPI assigned

May 11, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katie R Kickertz, DDS, MSNPI 1992934418

Title

Owner Dentist

Phone

(815) 222-2102

Specialties & licenses 1

Addresses

Other names 1

• Premier Endodontics of SouthPark Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katie Kickertz, DDS, MS

  • Endodontics
  • Charlotte, NC
  • NPI 1992934418
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1821788936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6842 CARNEGIE BLVD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113500",
            "telephone_number": "980-423-1272",
            "fax_number": "980-423-1273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6842 CARNEGIE BLVD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113500",
            "telephone_number": "980-423-1272",
            "fax_number": "980-423-1273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATIE KICKERTZ DDS MS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "KICKERTZ",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "815-222-2102",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Endodontics of SouthPark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine S Pak, DDS PLLC
• Kathryn J Sudikoff DMD PLLC
• Kathyrn D. Jendrasik-Savitsky, DMD, PA
• William G. Katibah III, M.D.
• Katie Blessing Center, LLC
• Ava Rose Katinas
• Bobby Kato, LPC
• Cara Deanna Kato, OTR
• Katrina M. Lavalliere, D.D.S, P.L.L.C.
• Katrina Renees Safe Place LLC

• Endodontics in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Endodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.