Provider Demographics
NPI:1417189853
Name:CHIQUES, CAMILLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:CHIQUES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 E 78TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1652
Mailing Address - Country:US
Mailing Address - Phone:787-370-8875
Mailing Address - Fax:
Practice Address - Street 1:447 E 78TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1652
Practice Address - Country:US
Practice Address - Phone:787-370-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0011761223D0004X
NY054601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist