Provider Demographics
NPI:1306910872
Name:MEYER, KATHY ANN (DDS)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:MEYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2747
Mailing Address - Country:US
Mailing Address - Phone:847-298-3041
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice