Provider Demographics
NPI:1578910071
Name:CAMACHO, MELANY (DDS)
Entity Type:Individual
Prefix:
First Name:MELANY
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 DEKALB AVE
Mailing Address - Street 2:1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3531
Mailing Address - Country:US
Mailing Address - Phone:571-228-5741
Mailing Address - Fax:
Practice Address - Street 1:1428 DEKALB AVE
Practice Address - Street 2:1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3531
Practice Address - Country:US
Practice Address - Phone:571-228-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058441122300000X
NY0011991223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist