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General NPI Number Information
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NPI Number | 1710025499
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Entity Type | Individual
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Provider Name | CAMILO MACHADO DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 31315 HARPER AVENUW
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City | ST. CLAIR SHORES
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State | MI
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Zip | 48082
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Country | US
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Telephone | 586-293-3434
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Fax | 586-293-4460
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Provider Business Mailing Address
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Address Line | 31315 HARPER AVENUE
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City | ST. CLAIR SHORES
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State | MI
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Zip | 48082
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Country | US
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Telephone | 586-293-3434
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Fax | 614-292-9422
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 71-000189
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1710025499
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License Number State | MI
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