Ronald Angelo Cannizzaro, DDS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Willowbrook, IL
NPI 1154483907 · NPPES record last updated Apr 7, 2020
Key facts
- NPI
- 1154483907
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 021000899 (IL)
- Practice address
- 545 Ridgemoor Drive
Willowbrook, IL 60527 - Phone
- (630) 654-1869
- Fax
- (708) 255-5524
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160210001098 | IL | Order and Referring Only - Dentist |
7618271784 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019014811 | IL | MD | Dentist |
| 021000899 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019014811 | IL | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 021000899 | IL | Yes |
Addresses
Primary practice location
545 Ridgemoor Drive
Willowbrook, IL 60527
Mailing address
545 Ridgemoor Drive
Willowbrook, IL 60527
Phone (630) 654-1869
Other providers in Willowbrook, IL
- Raysson Buckner Jr.
- Rudsen M Bueser
- Jennifer Buraga
- Burhani Clinic
- Jovan Butler
- Mary J Cannon
- Valbona Capani
- Joan T. Cardone
- Nicole Cardott
- Lynette Mae Carlson
All providers in Willowbrook, IL · Orthodontics and Dentofacial Orthopedics Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.