Provider Demographics
NPI:1649572330
Name:VICTOR R. CAMONES DDS INC
Entity Type:Organization
Organization Name:VICTOR R. CAMONES DDS INC
Other - Org Name:SANTA ROSA DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PROSTHODONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMONES
Authorized Official - Suffix:
Authorized Official - Credentials:43325
Authorized Official - Phone:714-990-0126
Mailing Address - Street 1:745 BREA BLVD
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:714-990-0126
Mailing Address - Fax:
Practice Address - Street 1:745 N. BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-990-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433251223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty