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General NPI Number Information
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NPI Number | 1073502464
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Entity Type | Individual
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Provider Name | JOSE F CAMACHO DDS
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3417 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4841
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Country | US
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Telephone | 773-342-2223
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Fax | 773-342-2225
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Provider Business Mailing Address
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Address Line | 2123 N LARAMIE AVE
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City | CHICAGO
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State | IL
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Zip | 60639-3125
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Country | US
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Telephone | 773-562-1798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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