Healthcare Provider Details

I. General information

NPI: 1942372453
Provider Name (Legal Business Name): KATRINA K SWEET DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA K FOSTER DDS

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 S BLACKSTONE AVE
CHICAGO IL
60619-7909
US

IV. Provider business mailing address

9021 S BLACKSTONE AVE
CHICAGO IL
60619-7909
US

V. Phone/Fax

Practice location:
  • Phone: 773-398-1413
  • Fax:
Mailing address:
  • Phone: 773-398-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1002046
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.003091
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12013584A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-026932
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: