MEDICARE: BERNARDO CAMPOS D.D.S. , P.A.

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1356644728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARDO CAMPOS D.D.S. , P.A.

Provider Business Mailing Address
First Line	:	1462 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3363
Country	:	US
Telephone Number	:	305-557-5282
Fax Number	:	305-557-4712

Provider Business Practice Location Address
First Line	:	1462 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3363
Country	:	US
Telephone Number	:	305-557-5282
Fax Number	:	305-557-4712

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BERNARDO CAMPOS
Credential	:	D.D.S.
Telephone Number	:	305-557-5282

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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