Provider Demographics
NPI:1578553632
Name:LAFAZANOS, CHRIS J (DDS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:J
Last Name:LAFAZANOS
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 1:625 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2001
Mailing Address - Country:US
Mailing Address - Phone:708-624-5685
Mailing Address - Fax:
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:SUITE 120
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:847-336-9165
Practice Address - Fax:847-336-9168
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice