Healthcare Provider Details

I. General information

NPI: 1154302313
Provider Name (Legal Business Name): JOSEPH LOUIS CAMACHO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 THOMAS JOHNSON DR SUITE A
FREDERICK MD
21702-4893
US

IV. Provider business mailing address

77 THOMAS JOHNSON DR SUITE A
FREDERICK MD
21702-4893
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-3887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9898
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: