MEDICARE: DR. RICHARD S CAMPOS DMD

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	1223G0001X	General Practice Dentistry	2019024194	MO
2	122300000X	Dentist	2019024194	MO

General Provider Information

NPI Number	:	1710530464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD S CAMPOS DMD

Provider Business Mailing Address
First Line	:	19 E GREGORY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1117
Country	:	US
Telephone Number	:	573-201-9262
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E GREGORY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1117
Country	:	US
Telephone Number	:	573-201-9262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	08/13/2024

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