Provider Demographics
NPI:1619132735
Name:LAVAGNOLLI, ROSANGELA CALIXTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSANGELA
Middle Name:CALIXTO
Last Name:LAVAGNOLLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1815
Mailing Address - Country:US
Mailing Address - Phone:773-286-0300
Mailing Address - Fax:773-286-0340
Practice Address - Street 1:4307 N. CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1815
Practice Address - Country:US
Practice Address - Phone:773-286-0300
Practice Address - Fax:773-286-0340
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0236191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice