Provider Demographics
NPI:1770903510
Name:KATENDE, ALAN (DDS)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:KATENDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 AVERY RANCH BLVD
Mailing Address - Street 2:UNIT 1927
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1690
Mailing Address - Country:US
Mailing Address - Phone:914-582-9810
Mailing Address - Fax:
Practice Address - Street 1:980 E KNIGHTS WAY STE 200
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548
Practice Address - Country:US
Practice Address - Phone:254-863-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-20
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31778122300000X
NY734751862390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program