Provider Demographics
NPI:1356648901
Name:NAPERVILLE DENTAL SPECIALISTS AND GENERAL ORAL HEALTH CARE
Entity Type:Organization
Organization Name:NAPERVILLE DENTAL SPECIALISTS AND GENERAL ORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVACCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-848-2010
Mailing Address - Street 1:55 S MAIN ST
Mailing Address - Street 2:SUITE 241
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5372
Mailing Address - Country:US
Mailing Address - Phone:630-848-2010
Mailing Address - Fax:
Practice Address - Street 1:55 S MAIN ST
Practice Address - Street 2:SUITE 241
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5372
Practice Address - Country:US
Practice Address - Phone:630-848-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty