MEDICARE: DR. KAITLYN LAGESSE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.032623	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019.032623	OTHER	IL	STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1205450509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAITLYN LAGESSE DMD

Provider Business Mailing Address
First Line	:	1700 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5324
Country	:	US
Telephone Number	:	312-620-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5324
Country	:	US
Telephone Number	:	312-620-7733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	05/04/2026

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