Ronald Angelo Cannizzaro, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021000899 Issued in IL

Practice address

545 Ridgemoor Drive
Willowbrook, IL 60527

Phone

(630) 654-1869

Fax

(708) 255-5524

NPI assigned

Dec 15, 2006

Last updated

Apr 7, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1154483907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 RIDGEMOOR DRIVE",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "60527",
            "telephone_number": "630-654-1869",
            "fax_number": "708-255-5524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 RIDGEMOOR DRIVE",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "60527",
            "telephone_number": "630-654-1869",
            "fax_number": "708-255-5524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNIZZARO",
        "first_name": "RONALD",
        "middle_name": "ANGELO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019014811",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021000899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raysson Buckner Jr., PTA
• Rudsen M Bueser, MD
• Jennifer Buraga, NP
• Burhani Clinic
• Jovan Butler, APRN
• Mary J Cannon, M.D.
• Valbona Capani, FNP
• Joan T. Cardone, M.D.
• Nicole Cardott, PT, DPT
• Lynette Mae Carlson, DHS, ATC

• Orthodontics and Dentofacial Orthopedics Dentistry in Willowbrook, IL
• Providers in Willowbrook, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.