MEDICARE: DR. ROSANGELA CALIXTO LAVAGNOLLI DDS

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
1	1223G0001X	General Practice Dentistry	019.023619	IL

General Provider Information

NPI Number	:	1619132735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSANGELA CALIXTO LAVAGNOLLI DDS

Provider Business Mailing Address
First Line	:	4307 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1815
Country	:	US
Telephone Number	:	773-286-0300
Fax Number	:	773-286-0340

Provider Business Practice Location Address
First Line	:	4307 N. CENTRAL AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1815
Country	:	US
Telephone Number	:	773-286-0300
Fax Number	:	773-286-0340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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