Provider Demographics
NPI:1669647491
Name:CAMACHO, GUILLERMO J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:J
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 W WEST COVINA PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2810
Mailing Address - Country:US
Mailing Address - Phone:626-960-2766
Mailing Address - Fax:626-962-8216
Practice Address - Street 1:1042 W WEST COVINA PKWY
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2810
Practice Address - Country:US
Practice Address - Phone:626-960-2766
Practice Address - Fax:626-962-8216
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist