Provider Demographics
NPI:1306064613
Name:KATHY MEYER DDS PC
Entity type:Organization
Organization Name:KATHY MEYER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-452-1879
Mailing Address - Street 1:7544 W NORTH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4141
Mailing Address - Country:US
Mailing Address - Phone:708-452-1879
Mailing Address - Fax:708-452-1893
Practice Address - Street 1:7544 W NORTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4141
Practice Address - Country:US
Practice Address - Phone:708-452-1879
Practice Address - Fax:708-452-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty