Organization
INNOVATIVE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY LAVACCA DMD (PRESIDENT)
(630) 848-2010
Entity
Organization
Contact information
Practice address
55 S MAIN ST STE 241, NAPERVILLE, IL 60540-5377
(630) 848-2010
(630) 848-2011
Mailing address
55 S MAIN ST STE 241, NAPERVILLE, IL 60540-5377
(630) 848-2010
(630) 848-2011
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4744296
IL
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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