Healthcare Provider Details

I. General information

NPI: 1245375138
Provider Name (Legal Business Name): SANTIAGO OCAMPO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

IV. Provider business mailing address

PO BOX 6260
HOLYOKE MA
01041-6260
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax: 413-539-9472
Mailing address:
  • Phone: 413-420-2200
  • Fax: 413-539-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8752
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: