Provider Demographics
NPI:1780866822
Name:GERGINIS, KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:GERGINIS
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 1:5962 N LINCOLN AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3711
Mailing Address - Country:US
Mailing Address - Phone:773-878-3168
Mailing Address - Fax:773-878-3317
Practice Address - Street 1:5962 N LINCOLN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3711
Practice Address - Country:US
Practice Address - Phone:773-878-3168
Practice Address - Fax:773-878-3317
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice