Individual
KATHERINE LYNN LEIVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1791 DEMPSEY CIR, PINGREE GROVE, IL 60140-8019
(815) 325-1114
Mailing address
1791 DEMPSEY CIR, PINGREE GROVE, IL 60140-8019
(815) 325-1114
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020012552
IL
Other
Enumeration date
12/17/2019
Last updated
12/17/2019
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