Provider Demographics
NPI:1982743605
Name:HART, KAI DANIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAI
Middle Name:DANIELLE
Last Name:HART
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 1:212 E SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1813
Mailing Address - Country:US
Mailing Address - Phone:217-532-3333
Mailing Address - Fax:217-532-6567
Practice Address - Street 1:212 E SUMMER ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1813
Practice Address - Country:US
Practice Address - Phone:217-532-3333
Practice Address - Fax:217-532-6567
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice