Healthcare Provider Details

I. General information

NPI: 1154235984
Provider Name (Legal Business Name): KAYLA JASMINE PAGE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 OHIO ST BLDG 1017
GREAT LAKES IL
60088-3155
US

IV. Provider business mailing address

3440 OHIO ST BLDG 1017
GREAT LAKES IL
60088-3155
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037472
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: