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NPI Code Detail

MEDICARE: DR. JOLMIRY ADRIANA CAMPOS

MEDICARE: DR. JOLMIRY ADRIANA CAMPOS
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
1390200000XStudent in an Organized Health Care Education/Training ProgramMA
2122300000XDentistDN10000480MA

General Provider Information

NPI Number : 1487419925
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOLMIRY ADRIANA CAMPOS
Provider Business Mailing Address
First Line : 89 E DEDHAM ST APT 317
Second Line :
City : BOSTON
State : MA
Zip : 02118-2658
Country : US
Telephone Number : 617-991-3548
Fax Number :
Provider Business Practice Location Address
First Line : 175 N FRANKLIN ST
Second Line :
City : HOLBROOK
State : MA
Zip : 02343-1171
Country : US
Telephone Number : 781-423-1370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2024
Last Update Date : 09/11/2024

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