Provider Demographics
NPI:1194954487
Name:OROURKE, KATRINA LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:LOUISE
Last Name:OROURKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:LOUISE
Other - Last Name:BAEVERSTAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE STE 1107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3123
Mailing Address - Country:US
Mailing Address - Phone:312-609-1300
Mailing Address - Fax:312-609-1308
Practice Address - Street 1:111 N WABASH AVE STE 1107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3123
Practice Address - Country:US
Practice Address - Phone:312-609-1300
Practice Address - Fax:312-609-1308
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist