Healthcare Provider Details

I. General information

NPI: 1386436863
Provider Name (Legal Business Name): MARIA REGINA TRINIDAD CAMARA ROXAS DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 SNEATH LN # 130
SAN BRUNO CA
94066-2409
US

IV. Provider business mailing address

5700 HIGHLANDS PLAZA DR APT 5051
SAINT LOUIS MO
63110-1381
US

V. Phone/Fax

Practice location:
  • Phone: 650-589-4563
  • Fax:
Mailing address:
  • Phone: 630-746-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number111022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: