Provider Demographics
NPI:1659858645
Name:JANDA, KATHERINE LANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LANE
Last Name:JANDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 E NEW YORK ST STE A10
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5163
Mailing Address - Country:US
Mailing Address - Phone:630-820-2020
Mailing Address - Fax:
Practice Address - Street 1:3015 E NEW YORK ST STE A10
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5163
Practice Address - Country:US
Practice Address - Phone:630-820-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0316301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty