Provider Demographics
NPI:1699428060
Name:BREDAU DENTAL LTD
Entity type:Organization
Organization Name:BREDAU DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVINIU
Authorized Official - Middle Name:
Authorized Official - Last Name:BREDAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-742-6038
Mailing Address - Street 1:3212 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1248
Mailing Address - Country:US
Mailing Address - Phone:773-742-6038
Mailing Address - Fax:
Practice Address - Street 1:5400 N MILWAUKEE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1289
Practice Address - Country:US
Practice Address - Phone:773-853-2380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty