Healthcare Provider Details

I. General information

NPI: 1073709440
Provider Name (Legal Business Name): CHRISTOPHER A. MCCAFFREY-BOSS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 N BROADWAY ST
CHICAGO IL
60613-2110
US

IV. Provider business mailing address

4009 N BROADWAY ST
CHICAGO IL
60613-2110
US

V. Phone/Fax

Practice location:
  • Phone: 773-275-2586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4932
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-024309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: