Healthcare Provider Details

I. General information

NPI: 1407178940
Provider Name (Legal Business Name): OSCAR MACHADO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLES 3 Y 4, AVE 6 #380
AGUA PRIETA SONORA
84206
MX

IV. Provider business mailing address

PO BOX 12385
EL PASO TX
79913-0385
US

V. Phone/Fax

Practice location:
  • Phone: 526333384460
  • Fax:
Mailing address:
  • Phone: 915-449-8589
  • Fax: 915-239-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1818768
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: