MEDICARE: DR. FERNANDO CAMPOS D.D.S.

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	1223G0001X	General Practice Dentistry	DN12233	FL

General Provider Information

NPI Number	:	1649202458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO CAMPOS D.D.S.

Provider Business Mailing Address
First Line	:	1855 N UNIVERSITY DR
Second Line	:	#1833
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065
Country	:	US
Telephone Number	:	954-994-4949
Fax Number	:	954-341-5271

Provider Business Practice Location Address
First Line	:	1855 N UNIVERSITY DR
Second Line	:	#1833
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071
Country	:	US
Telephone Number	:	954-344-4949
Fax Number	:	954-341-5271

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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