Healthcare Provider Details

I. General information

NPI: 1386292324
Provider Name (Legal Business Name): AARON JONATHAN CAMACHO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44558 10TH ST W
LANCASTER CA
93534-3333
US

IV. Provider business mailing address

42530 36TH ST W
LANCASTER CA
93536-4104
US

V. Phone/Fax

Practice location:
  • Phone: 661-206-2424
  • Fax:
Mailing address:
  • Phone: 661-350-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: