Provider Demographics
NPI:1023167194
Name:LAMBERGHINI, FLAVIA (DDS, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:FLAVIA
Middle Name:
Last Name:LAMBERGHINI
Suffix:
Gender:F
Credentials:DDS, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3012 W FULLERTON AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2808
Mailing Address - Country:US
Mailing Address - Phone:312-622-6511
Mailing Address - Fax:773-384-3963
Practice Address - Street 1:3012 W FULLERTON AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2808
Practice Address - Country:US
Practice Address - Phone:312-622-6511
Practice Address - Fax:773-384-3963
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190259651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019025965Medicaid
IL1004927Medicaid