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General NPI Number Information
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NPI Number | 1952511602
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Entity Type | Individual
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Provider Name | ANTHONY LAVACCA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 55 S MAIN ST SUITE 241
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City | NAPERVILLE
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State | IL
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Zip | 60540-5372
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Country | US
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Telephone | 312-246-6683
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Fax | 312-236-3257
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE SUITE 2010
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-236-3253
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Fax | 312-236-3257
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State | IL
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