Healthcare Provider Details

I. General information

NPI: 1700959723
Provider Name (Legal Business Name): CAMEO ENDODONTICS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 NORTH AVE
RIVER FOREST IL
60305-1133
US

IV. Provider business mailing address

7603 NORTH AVE
RIVER FOREST IL
60305-1133
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-7787
  • Fax: 708-689-0853
Mailing address:
  • Phone: 708-456-7787
  • Fax: 708-689-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-001024
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-001876
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-002071
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-002464
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-001106
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-002519
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21-002515
License Number StateIL
# 8
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-001023
License Number StateIL

VIII. Authorized Official

Name: DR. RICHARD MUNARETTO
Title or Position: PRESIDENT
Credential:
Phone: 708-456-7787