MEDICARE: BERNARDO 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	1223G0001X	General Practice Dentistry	DN0010000	FL

General Provider Information

NPI Number	:	1851403273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARDO CAMPOS

Provider Business Mailing Address
First Line	:	1462 W 84TH ST
Second Line	:	P.O. BOX 5099
City	:	HIALEAH
State	:	FL
Zip	:	33014-3363
Country	:	US
Telephone Number	:	305-557-5282
Fax Number	:	305-557-4712

Provider Business Practice Location Address
First Line	:	1462 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3363
Country	:	US
Telephone Number	:	305-824-3641
Fax Number	:	305-557-4712

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/09/2007

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Directions to “ BERNARDO CAMPOS ” Practice Location

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