Provider Demographics
NPI:1467626705
Name:CAMODECA, SILVIO J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SILVIO
Middle Name:J
Last Name:CAMODECA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2418
Mailing Address - Country:US
Mailing Address - Phone:773-365-0315
Mailing Address - Fax:
Practice Address - Street 1:3518 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2418
Practice Address - Country:US
Practice Address - Phone:773-365-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12010612A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist