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General NPI Number Information
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NPI Number | 1376651232
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Entity Type | Individual
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Provider Name | LISA KATHERINE KEARNEY DDS
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 4751 N KEDZIE AVE 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60625
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Country | US
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Telephone | 312-432-4360
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 N FAIRFIELD AVE APT 2S
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City | CHICAGO
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State | IL
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Zip | 60647-1863
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Country | US
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Telephone | 773-292-0655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-026123
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019026123
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License Number State | IL
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