Provider Demographics
NPI:1639100993
Name:FAMILARO, ROBERT JOHN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:FAMILARO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 W 95TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2700
Mailing Address - Country:US
Mailing Address - Phone:708-598-8188
Mailing Address - Fax:708-598-8288
Practice Address - Street 1:8700 W 95TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2700
Practice Address - Country:US
Practice Address - Phone:708-598-8188
Practice Address - Fax:708-598-8288
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL545410Medicare ID - Type Unspecified
ILT38655Medicare UPIN