# INNOVATIVE PEDIATRIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447644802
- **Authorized official:** DR. ANTHONY LAVACCA DMD (PRESIDENT)
- **Authorized official phone:** (630) 848-2010

## Contact information

- **Practice address:** 55 S MAIN ST STE 241, NAPERVILLE, IL 60540-5377
- **Practice address phone:** (630) 848-2010
- **Practice address fax:** (630) 848-2011
- **Mailing address:** 55 S MAIN ST STE 241, NAPERVILLE, IL 60540-5377
- **Mailing address phone:** (630) 848-2010
- **Mailing address fax:** (630) 848-2011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4744296 | IL | Yes |

## Other

- **Enumeration date:** 03/24/2015
- **Last updated:** 03/24/2015