Healthcare Provider Details

I. General information

NPI: 1528636321
Provider Name (Legal Business Name): CATHERINE ROBERTS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W WELLINGTON AVE FL 1
CHICAGO IL
60657-6709
US

IV. Provider business mailing address

913 W WELLINGTON AVE FL 1
CHICAGO IL
60657-6709
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-1461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number137.001169
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043187
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.033546
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: