Healthcare Provider Details

I. General information

NPI: 1578910071
Provider Name (Legal Business Name): MELANY CAMACHO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 DEKALB AVE 1F
BROOKLYN NY
11237-3531
US

IV. Provider business mailing address

1428 DEKALB AVE 1F
BROOKLYN NY
11237-3531
US

V. Phone/Fax

Practice location:
  • Phone: 571-228-5741
  • Fax:
Mailing address:
  • Phone: 571-228-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number058441
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number001199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: