MEDICARE: SIMONA LILIANA KATONA LICENSED DENTIST

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	1223G0001X	General Practice Dentistry	019027226	IL

General Provider Information

NPI Number	:	1396971768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONA LILIANA KATONA LICENSED DENTIST

Provider Business Mailing Address
First Line	:	4541 N RAVENSWOOD AVE STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5275
Country	:	US
Telephone Number	:	312-502-8073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3935 N WESTERN AVE UNIT 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3761
Country	:	US
Telephone Number	:	773-588-1141
Fax Number	:

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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