Provider Demographics
NPI:1730392499
Name:SERGIO OCAMPO DDS PC
Entity type:Organization
Organization Name:SERGIO OCAMPO DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-902-9898
Mailing Address - Street 1:15769 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2510
Mailing Address - Country:US
Mailing Address - Phone:562-902-9898
Mailing Address - Fax:562-902-9797
Practice Address - Street 1:15769 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2510
Practice Address - Country:US
Practice Address - Phone:562-902-9898
Practice Address - Fax:562-902-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty