Provider Demographics
NPI:1972711158
Name:DR. LUIS DANIEL CAMACHO C.S.P.
Entity type:Organization
Organization Name:DR. LUIS DANIEL CAMACHO C.S.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-265-3683
Mailing Address - Street 1:114 CALLE MCKINLEY W STE 107
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-3866
Mailing Address - Country:US
Mailing Address - Phone:787-265-3683
Mailing Address - Fax:787-834-1251
Practice Address - Street 1:114 CALLE MCKINLEY W STE 107
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3866
Practice Address - Country:US
Practice Address - Phone:787-265-3683
Practice Address - Fax:787-834-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty