Provider Demographics
NPI:1932312428
Name:WATERLOO, CATHY S (DDS)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:S
Last Name:WATERLOO
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 1:523 PARK DR
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1082
Mailing Address - Country:US
Mailing Address - Phone:847-251-8990
Mailing Address - Fax:847-853-0797
Practice Address - Street 1:523 PARK DR
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1082
Practice Address - Country:US
Practice Address - Phone:847-251-8990
Practice Address - Fax:847-853-0797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019228771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice