Provider Demographics
NPI:1629742580
Name:KATIB, NORA RANDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:RANDA
Last Name:KATIB
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 1:3215 HOLSEN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2752
Mailing Address - Country:US
Mailing Address - Phone:262-844-3085
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE STE 890
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8683
Practice Address - Country:US
Practice Address - Phone:312-642-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0333141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice