MEDICARE: DR. ANGELO MAIGUE CAMERINO DDS

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
1	122300000X	Dentist	9469	CO

General Provider Information

NPI Number	:	1033318563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELO MAIGUE CAMERINO DDS

Provider Business Mailing Address
First Line	:	1720 JET STREAM DR
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3938
Country	:	US
Telephone Number	:	719-481-8373
Fax Number	:	719-481-8302

Provider Business Practice Location Address
First Line	:	1720 JET STREAM DR
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3938
Country	:	US
Telephone Number	:	719-481-8373
Fax Number	:	719-481-8302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2007
Last Update Date	:	10/24/2007

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