Provider Demographics
NPI:1528061520
Name:LAUTERBACH, KATHERINE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:LAUTERBACH
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 1:716 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2512
Mailing Address - Country:US
Mailing Address - Phone:847-869-9950
Mailing Address - Fax:847-869-4637
Practice Address - Street 1:1642 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3018
Practice Address - Country:US
Practice Address - Phone:773-472-1200
Practice Address - Fax:773-472-1661
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190178771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice