Basic Information
| Provider Information | |||||||||
| NPI: | 1215183058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEPRIN | ||||||||
| FirstName: | KATHEERINE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2049 N SHEFFIELD AVE | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606146909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374783656 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 E HURON ST | ||||||||
| Address2: | GALTER PAVILION | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129263264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 1684 | IL | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1684 | 01 | IL | ILLINOIS STATE DENTAL TEMPORARY TRAINING LICENSE | OTHER |