Provider Demographics
NPI:1841758349
Name:CESARIO, BRANDON DAVID (DMD)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:DAVID
Last Name:CESARIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 N MILWAUKEE AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2389
Mailing Address - Country:US
Mailing Address - Phone:312-967-0103
Mailing Address - Fax:
Practice Address - Street 1:1229 W WASHINGTON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2133
Practice Address - Country:US
Practice Address - Phone:312-967-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL8551223P0221X
IL0210031321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid