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NPI Code Detail

MEDICARE: DR. CHRISTIAN XAVIER CAICEDO MORENO DMD

MEDICARE: DR. CHRISTIAN XAVIER CAICEDO MORENO DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019.032183IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1019.032183OTHERILDENTAL LICENSE

General Provider Information

NPI Number : 1306407812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTIAN XAVIER CAICEDO MORENO DMD
Provider Business Mailing Address
First Line : 1873 SHERMER RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-5300
Country : US
Telephone Number : 813-598-8638
Fax Number :
Provider Business Practice Location Address
First Line : 1873 SHERMER RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-5300
Country : US
Telephone Number : 847-498-5970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2019
Last Update Date : 04/29/2026

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