Provider Demographics
NPI:1740268416
Name:SILVIO J CAMODECA DDS DN
Entity type:Organization
Organization Name:SILVIO J CAMODECA DDS DN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMODECA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS DN
Authorized Official - Phone:773-278-0334
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
Mailing Address - Country:US
Mailing Address - Phone:773-278-0334
Mailing Address - Fax:773-365-0314
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
Practice Address - Country:US
Practice Address - Phone:773-278-0334
Practice Address - Fax:773-365-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015351122300000X
IN12010C12A122300000X
DCNAT1000255175F00000X
IL181000299204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNAT1000255OtherNATUROPATHY
IN12010612AOtherDENTISTRY
IL019015351OtherDENTISTRY
IL181000299OtherNAPRAPATH