Individual
DR. LISA KATHERINE KEARNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4751 N KEDZIE AVE, 2ND FLOOR, CHICAGO, IL 60625
(312) 432-4360
Mailing address
2710 N FAIRFIELD AVE APT 2S, CHICAGO, IL 60647-1863
(773) 292-0655
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026123
IL
1223G0001X
General Practice Dentistry
019-026123
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9184040
—
IL
Enumeration date
08/29/2006
Last updated
08/09/2021
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