Provider Demographics
NPI:1912638362
Name:MACH, KAITLIN JEANNETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:JEANNETTE
Last Name:MACH
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 1:10615 SUNNINGDALE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8124
Mailing Address - Country:US
Mailing Address - Phone:630-677-0144
Mailing Address - Fax:
Practice Address - Street 1:2161 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1679
Practice Address - Country:US
Practice Address - Phone:630-893-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist