| Innovative Pediatric Dentistry | |
|
55 S Main St Ste 241 Naperville IL 60540-5377 | |
| (630) 848-2010 | |
| (630) 848-2011 |
| Full Name | Innovative Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 55 S Main St Ste 241, Naperville, Illinois |
| Authorized Official Name and Position | Anthony Lavacca (PRESIDENT) |
| Authorized Official Contact | 6308482010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Pediatric Dentistry 55 S Main St Ste 241 Naperville IL 60540-5377 Ph: (630) 848-2010 | Innovative Pediatric Dentistry 55 S Main St Ste 241 Naperville IL 60540-5377 Ph: (630) 848-2010 |
| NPI Number | 1447644802 |
|---|---|
| Provider Enumeration Date | 03/24/2015 |
| Last Update Date | 03/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447644802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 4744296 (Illinois) | Primary |
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