Active NPI
Silvio J Camodeca, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1467626705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12010612A
- Practice address
- 3518 W Fullerton Ave
Chicago, IL 60647-2418 - Phone
- (773) 365-0315
- NPI assigned
- Apr 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12010612A | IL | Primary |
Addresses
Primary practice location
3518 W Fullerton Ave
Chicago, IL 60647-2418
Mailing address
3518 W Fullerton Ave
Chicago, IL 60647-2418
Phone (773) 365-0315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160623001390 | IN | Order and Referring Only - Oral Surgery | 1355632225 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010612A | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1467626705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3518 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606472418",
"telephone_number": "773-365-0315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3518 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606472418",
"telephone_number": "773-365-0315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMODECA",
"first_name": "SILVIO",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-17",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "12010612A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.