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NPI Code Detail

MEDICARE: CAMILO O MOYNELO COLL DMD

MEDICARE:   CAMILO O MOYNELO COLL  DMD
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 DentistryDN23641FL

General Provider Information

NPI Number : 1376039115
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILO O MOYNELO COLL DMD
Provider Business Mailing Address
First Line : 13707 BARBERRY DR
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-8143
Country : US
Telephone Number : 305-302-7367
Fax Number :
Provider Business Practice Location Address
First Line : 1620 S CONGRESS AVE STE 102
Second Line :
City : PALM SPRINGS
State : FL
Zip : 33461-2128
Country : US
Telephone Number : 561-508-5930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2018
Last Update Date : 08/15/2021

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Directions to “ CAMILO O MOYNELO COLL DMD” Practice Location

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