Provider Demographics
NPI:1427365444
Name:CAMPOS, BERNADETE M
Entity Type:Individual
Prefix:DR
First Name:BERNADETE
Middle Name:M
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERNADETE
Other - Middle Name:
Other - Last Name:THERRIAULT CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1830
Mailing Address - Country:US
Mailing Address - Phone:978-587-5838
Mailing Address - Fax:
Practice Address - Street 1:127 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1830
Practice Address - Country:US
Practice Address - Phone:978-927-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10842122300000X
MADN18570081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist