Provider Demographics
NPI:1548822497
Name:UNES, KATHERINE M
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:UNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11323 N PAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9796
Mailing Address - Country:US
Mailing Address - Phone:309-251-2175
Mailing Address - Fax:
Practice Address - Street 1:11323 N PAWNEE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9796
Practice Address - Country:US
Practice Address - Phone:309-251-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180430831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice