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NPI Code Detail

MEDICARE: DIENTES, INC.

MEDICARE: DIENTES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1023155751
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIENTES, INC.
Provider Business Mailing Address
First Line : 3417 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4841
Country : US
Telephone Number : 773-342-2223
Fax Number : 773-342-2225
Provider Business Practice Location Address
First Line : 3417 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4841
Country : US
Telephone Number : 773-342-2223
Fax Number : 773-342-2225
Authorized Official
Title or Position : DOCTOR OF DENTAL SURGERY
Name : DR. JOSE F CAMACHO
Credential : D.D.S.
Telephone Number : 773-342-2223
Provider Enumeration Date : 01/31/2007
Last Update Date : 08/22/2020

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Directions to “DIENTES, INC. ” Practice Location

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