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NPI Code Detail

MEDICARE: NORTHBROOK FAMILY DENTAL PLLC

MEDICARE: NORTHBROOK FAMILY DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1942147962
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHBROOK FAMILY DENTAL PLLC
Provider Business Mailing Address
First Line : 1873 SHERMER RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-5300
Country : US
Telephone Number : 847-498-5970
Fax Number :
Provider Business Practice Location Address
First Line : 1873 SHERMER RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-5300
Country : US
Telephone Number : 847-498-5970
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. CHRISTIAN X CAICEDO MORENO
Credential : DMD
Telephone Number : 813-598-8638
Provider Enumeration Date : 04/29/2026
Last Update Date : 04/29/2026

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Directions to “NORTHBROOK FAMILY DENTAL PLLC ” Practice Location

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