1740268416 NPI number — SILVIO J CAMODECA DDS DN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740268416 NPI number — SILVIO J CAMODECA DDS DN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVIO J CAMODECA DDS DN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740268416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3518 W FULLERTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-278-0334
Provider Business Mailing Address Fax Number:
773-365-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3518 W FULLERTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-278-0334
Provider Business Practice Location Address Fax Number:
773-365-0314
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMODECA
Authorized Official First Name:
SILVIO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-278-0334

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  12010C12A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: NAT1000255 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X , with the licence number: 181000299 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 019015351 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NAT1000255 . This is a "NATUROPATHY" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 12010612A . This is a "DENTISTRY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 019015351 . This is a "DENTISTRY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 181000299 . This is a "NAPRAPATH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com