Provider Demographics
NPI:1083458483
Name:ORTH, CATHERINE MARIAH
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIAH
Last Name:ORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S MILTON RD APT 302D
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1617
Mailing Address - Country:US
Mailing Address - Phone:907-792-9411
Mailing Address - Fax:
Practice Address - Street 1:208 E PINE KNOLL DRIVE BUILD 66
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011-0001
Practice Address - Country:US
Practice Address - Phone:928-523-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist