Provider Demographics
NPI:1346308970
Name:DE OCAMPO, VICENTE BERNAL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:BERNAL
Last Name:DE OCAMPO
Suffix:JR
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 1:634A WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6214
Mailing Address - Country:US
Mailing Address - Phone:707-399-8569
Mailing Address - Fax:707-399-8647
Practice Address - Street 1:634A WEBSTER ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6214
Practice Address - Country:US
Practice Address - Phone:707-399-8569
Practice Address - Fax:707-399-8647
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-26375-03OtherMEDICAL ID NUMBER