Healthcare Provider Details

I. General information

NPI: 1487863817
Provider Name (Legal Business Name): FLAVIO ANTHONY CAJIAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 N MILWAUKEE AVE
CHICAGO IL
60647-1609
US

IV. Provider business mailing address

2605 N MILWAUKEE AVE
CHICAGO IL
60647-1609
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-2288
  • Fax: 773-278-2284
Mailing address:
  • Phone: 773-278-2288
  • Fax: 773-278-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: