Provider Demographics
NPI:1013414655
Name:SANCHEZ, FLAVIO JOSE CASTELLI (BDS, MS)
Entity Type:Individual
Prefix:
First Name:FLAVIO
Middle Name:JOSE CASTELLI
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 W MONROE ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2572
Mailing Address - Country:US
Mailing Address - Phone:312-523-9228
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST RM 131
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-523-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1360002221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty