Joseph E Canzona, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

21-000762 Issued in IL

Practice address

2500 Ridge Ave
Suite 302
Evanston, IL 60201-2455

Phone

(847) 328-8899

Fax

(847) 328-3545

NPI assigned

Jan 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Joseph Canzona DDS MD LTD

  • Medical Specialty Clinic/Center
  • Evanston, IL
  • NPI 1104099324
  NPD (past) Authorized official
• Lakeside Oral & Facial Surgery Institute

  • Oral and Maxillofacial Surgery Clinic/Center
  • Evanston, IL
  • NPI 1205288982
  NPD (past)

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1265411276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE",
            "address_2": "SUITE 302",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012455",
            "telephone_number": "847-328-8899",
            "fax_number": "847-328-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE",
            "address_2": "SUITE 302",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012455",
            "telephone_number": "847-328-8899",
            "fax_number": "847-328-3545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANZONA",
        "first_name": "JOSEPH",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "21-000762",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "19-13567",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "36-064858",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "36-3349069",
            "identifier": "TAX ID",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel M Canel, CRNA
• Renee Canik
• Barbara Trinidad Canlas, DDS
• Carol R Cann, MA, LCPC, CADC
• Gail P Canning
• Michael S Caplan, MD
• Elysia Cappellucci, APN
• Alexandra C. Carani, APN-CRNA
• Bobby Carbage, MS, CRADC
• Cardiovascular Associates of Glenbrook & Evanston LLC

• Oral and Maxillofacial Surgery (Dentist) in Evanston, IL
• Providers in Evanston, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.