Provider Demographics
NPI:1740407279
Name:OCAMPO, GREGORY J (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:OCAMPO
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 1:1994 MAIN ST # D
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3066
Mailing Address - Country:US
Mailing Address - Phone:831-724-7400
Mailing Address - Fax:
Practice Address - Street 1:1994 MAIN ST # D
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3066
Practice Address - Country:US
Practice Address - Phone:831-724-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0333481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice