Individual
DR. JOSEPH E CANZONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
2500 RIDGE AVE, SUITE 302, EVANSTON, IL 60201-2455
(847) 328-8899
(847) 328-3545
Mailing address
2500 RIDGE AVE, SUITE 302, EVANSTON, IL 60201-2455
(847) 328-8899
(847) 328-3545
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
19-13567
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
21-000762
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
36-064858
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TAX ID
36-3349069
IL
Enumeration date
01/10/2006
Last updated
07/22/2008
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