Provider Demographics
NPI:1003016338
Name:CAMPOS, MARIA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2501
Mailing Address - Country:US
Mailing Address - Phone:212-375-1160
Mailing Address - Fax:212-375-1169
Practice Address - Street 1:191 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2501
Practice Address - Country:US
Practice Address - Phone:212-375-1160
Practice Address - Fax:212-375-1169
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist