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General NPI Number Information
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NPI Number | 1740268416
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Entity Type | Organization
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Legal Business Name | SILVIO J CAMODECA DDS DN
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 3518 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647
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Country | US
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Telephone | 773-278-0334
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Fax | 773-365-0314
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Provider Business Mailing Address
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Address Line | 3518 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647
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Country | US
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Telephone | 773-278-0334
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Fax | 773-365-0314
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Authorized Official
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Title or Position | OWNER
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Name | DR. SILVIO J CAMODECA
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Credential | DDS DN
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Telephone | 773-278-0334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010C12A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NAT1000255
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 181000299
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019015351
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License Number State | IL
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