Provider Demographics
NPI:1861649402
Name:MEDEIROS, EARL CATON (DDS)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:CATON
Last Name:MEDEIROS
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 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 390
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-355-2555
Mailing Address - Fax:630-355-2457
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 390
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-355-2555
Practice Address - Fax:630-355-2457
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA117651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice