Provider Demographics
NPI:1376738245
Name:BREDAU, LAVINIU (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAVINIU
Middle Name:
Last Name:BREDAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 N MILWAUKEE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1289
Mailing Address - Country:US
Mailing Address - Phone:773-853-2380
Mailing Address - Fax:
Practice Address - Street 1:5400 N MILWAUKEE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1289
Practice Address - Country:US
Practice Address - Phone:773-853-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287441223G0001X
IL0190274771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice