MEDICARE: DR. BERNADETE M CAMPOS

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	DL10842	MA
2	1223G0001X	General Practice Dentistry	DN1857008	MA

General Provider Information

NPI Number	:	1427365444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNADETE M CAMPOS

Provider Business Mailing Address
First Line	:	127 DODGE ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-1830
Country	:	US
Telephone Number	:	978-587-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 DODGE ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-1830
Country	:	US
Telephone Number	:	978-927-3550
Fax Number	:

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	12/02/2019

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