Provider Demographics
NPI:1043965866
Name:KATRINA BAEVERSTAD DDS LLC
Entity Type:Organization
Organization Name:KATRINA BAEVERSTAD DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BAEVERSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-609-1300
Mailing Address - Street 1:111 N WABASH AVE STE 1107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3123
Mailing Address - Country:US
Mailing Address - Phone:312-609-1300
Mailing Address - Fax:312-609-1306
Practice Address - Street 1:111 N WABASH AVE STE 1107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3123
Practice Address - Country:US
Practice Address - Phone:312-609-1300
Practice Address - Fax:312-609-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental