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NPI Code Detail

MEDICARE: DR. JOSE F CAMACHO DDS

MEDICARE: DR. JOSE F CAMACHO DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1073502464
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE F CAMACHO DDS
Provider Business Mailing Address
First Line : 2123 N LARAMIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-3125
Country : US
Telephone Number : 773-562-1798
Fax Number :
Provider Business Practice Location Address
First Line : 3417 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4841
Country : US
Telephone Number : 773-342-2223
Fax Number : 773-342-2225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 07/08/2007

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Directions to “ DR. JOSE F CAMACHO DDS” Practice Location

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