Provider Demographics
NPI:1770935181
Name:PASSOLT, KARA (DMD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:
Last Name:PASSOLT
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 1:1222 W MADISON ST
Mailing Address - Street 2:APT 222
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2044
Mailing Address - Country:US
Mailing Address - Phone:224-422-9693
Mailing Address - Fax:
Practice Address - Street 1:638 N INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1374
Practice Address - Country:US
Practice Address - Phone:815-886-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190307341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice