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General NPI Number Information
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NPI Number | 1699428060
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Entity Type | Organization
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Legal Business Name | BREDAU DENTAL LTD
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 01/26/2022
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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 | 3212 RAYMOND AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1248
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Country | US
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Telephone | 773-742-6038
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAVINIU BREDAU
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Credential | DDS
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Telephone | 773-742-6038
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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 |
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License Number State |
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