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General NPI Number Information
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NPI Number | 1265411276
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Entity Type | Individual
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Provider Name | JOSEPH E CANZONA DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2500 RIDGE AVE SUITE 302
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City | EVANSTON
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State | IL
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Zip | 60201-2455
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Country | US
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Telephone | 847-328-8899
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Fax | 847-328-3545
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Provider Business Mailing Address
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Address Line | 2500 RIDGE AVE SUITE 302
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City | EVANSTON
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State | IL
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Zip | 60201-2455
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Country | US
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Telephone | 847-328-8899
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Fax | 847-328-3545
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 21-000762
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19-13567
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 36-064858
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License Number State | IL
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