Individual
KATHARINA ATMADJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
801 S PAULINA ST, ROOM 301, CHICAGO, IL 60612-7210
(312) 996-1036
Mailing address
801 S PAULINA ST, ROOM 301, CHICAGO, IL 60612-7210
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
136-000193
IL
Other
Enumeration date
07/31/2015
Last updated
07/31/2015
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