Provider Demographics
NPI:1376791764
Name:KLOCK, KATHERINE JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JANE
Last Name:KLOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E CENTRAL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2857
Mailing Address - Country:US
Mailing Address - Phone:847-253-4626
Mailing Address - Fax:847-253-4650
Practice Address - Street 1:1300 E CENTRAL RD
Practice Address - Street 2:SUITE D
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2857
Practice Address - Country:US
Practice Address - Phone:847-253-4626
Practice Address - Fax:847-253-4650
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190184901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice