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General NPI Number Information
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NPI Number | 1376738245
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Entity Type | Individual
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Provider Name | LAVINIU BREDAU D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 5400 N MILWAUKEE AVE STE A
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City | CHICAGO
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State | IL
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Zip | 60630-1289
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Country | US
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Telephone | 773-853-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 N MILWAUKEE AVE STE A
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City | CHICAGO
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State | IL
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Zip | 60630-1289
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Country | US
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Telephone | 773-853-2380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28744
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019027477
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License Number State | IL
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