Provider Demographics
NPI:1710116785
Name:FABER, KATHERINE LAINE KINNEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LAINE KINNEY
Last Name:FABER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:LAINE
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:609 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-0665
Mailing Address - Country:US
Mailing Address - Phone:815-725-8170
Mailing Address - Fax:
Practice Address - Street 1:609 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-0665
Practice Address - Country:US
Practice Address - Phone:815-725-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0280001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice