Healthcare Provider Details

I. General information

NPI: 1336368125
Provider Name (Legal Business Name): CHARMAINE T CHA CAMP DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13605 BADEN WESTWOOD ROAD
BRANDYWINE MD
20613
US

IV. Provider business mailing address

9440 PENNSYLVANIA AVENUE #160
UPPER MARLBORO MD
20772
US

V. Phone/Fax

Practice location:
  • Phone: 301-888-2233
  • Fax: 301-888-9133
Mailing address:
  • Phone: 301-599-0460
  • Fax: 301-599-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13607
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: