Provider Demographics
NPI:1326183302
Name:BEDOYA, MANUEL CAMACHO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:CAMACHO
Last Name:BEDOYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 S. MISSION ROAD
Mailing Address - Street 2:P.O. BOX 26586
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85726-6586
Mailing Address - Country:US
Mailing Address - Phone:520-320-5500
Mailing Address - Fax:520-320-5502
Practice Address - Street 1:801 N WILMOT RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1711
Practice Address - Country:US
Practice Address - Phone:520-320-5500
Practice Address - Fax:520-320-5502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist