=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700632064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMPOS-BELUSSI FAMILY DENTAL P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2024
-----------------------------------------------------
Last Update Date | 04/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 254 COCHITUATE RD
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01701-5041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-875-1060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 254 COCHITUATE RD
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01701-5041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-875-1060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HUGO C CAMPOS
-----------------------------------------------------
Credential | DMD, MDSC
-----------------------------------------------------
Telephone | 860-995-3599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------