Provider Demographics
NPI:1235623224
Name:CAMACHO, JESSIE CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:CAROLINA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JESSIE
Other - Middle Name:CAROLINA
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2406 GESSNER RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5008
Mailing Address - Country:US
Mailing Address - Phone:713-465-4155
Mailing Address - Fax:713-465-1090
Practice Address - Street 1:2406 GESSNER RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5008
Practice Address - Country:US
Practice Address - Phone:713-465-4155
Practice Address - Fax:713-465-1090
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist