Phillip Cannizzaro, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A13321 Issued in IL

Practice address

3006 Desplaines Ave
North Riverside, IL 60546-1861

Phone

(708) 447-8385

Fax

(708) 447-8400

NPI assigned

Dec 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1183852800000",
    "number": "1629130620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3006 S. DESPLAINES AVE.",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "60546",
            "telephone_number": "708-447-8385",
            "fax_number": "708-447-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3006 DESPLAINES AVE",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "605461861",
            "telephone_number": "708-447-8385",
            "fax_number": "708-447-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNIZZARO",
        "first_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A13321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Berardino
• Patrice R Blackburn, MHS, CCC-SLP
• Lluvia Esperanza Blancarte
• Kathryn Brady, DO
• Vanessa Burns
• Carl J Novotny DO SC
• Colby Lee Carter, OD
• Alexandra Castro
• Caroline Chade
• Chicago Mall Dental Associates, LLC

• General Practice Dentistry in North Riverside, IL
• Providers in North Riverside, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.