Provider Demographics
NPI:1245266204
Name:CAMACHO, GEORGE S (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:BAYAMON BRANCH
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0787
Mailing Address - Country:US
Mailing Address - Phone:787-797-9450
Mailing Address - Fax:
Practice Address - Street 1:AB5 AVE LAS CUMBRES
Practice Address - Street 2:URB. REXVILLE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4161
Practice Address - Country:US
Practice Address - Phone:787-730-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice