Individual provider Active NPI

Katherine Jane Klock, D.D.S.

  • General Practice Dentistry
  • Arlington Heights, IL
National Provider Identifier
1376791764
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019018490 Issued in IL
Practice address
1300 E Central Rd
Suite D
Arlington Heights, IL 60005-2857
Phone
(847) 253-4626
Fax
(847) 253-4650
NPI assigned
Aug 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019018490 IL Primary

Addresses

Primary practice location

1300 E Central Rd
Suite D
Arlington Heights, IL 60005-2857

Mailing address

1300 E Central Rd
Suite D
Arlington Heights, IL 60005-2857
Phone (847) 253-4626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
019018490ILMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1376791764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E CENTRAL RD",
            "address_2": "SUITE D",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600052857",
            "telephone_number": "847-253-4626",
            "fax_number": "847-253-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CENTRAL RD",
            "address_2": "SUITE D",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600052857",
            "telephone_number": "847-253-4626",
            "fax_number": "847-253-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCK",
        "first_name": "KATHERINE",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-28",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019018490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.