Provider Demographics
NPI:1265585244
Name:CAMUCCIO, JOSEPH MARIO (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARIO
Last Name:CAMUCCIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 NE 14TH STREET CSWY
Mailing Address - Street 2:#102
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3561
Mailing Address - Country:US
Mailing Address - Phone:954-781-6170
Mailing Address - Fax:954-781-6725
Practice Address - Street 1:2700 NE 14TH STREET CSWY
Practice Address - Street 2:#102
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3561
Practice Address - Country:US
Practice Address - Phone:954-781-6170
Practice Address - Fax:954-781-6725
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 56651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice