Provider Demographics
NPI:1851403273
Name:CAMPOS, BERNARDO
Entity Type:Individual
Prefix:
First Name:BERNARDO
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 W 84TH ST
Mailing Address - Street 2:P.O. BOX 5099
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3363
Mailing Address - Country:US
Mailing Address - Phone:305-557-5282
Mailing Address - Fax:305-557-4712
Practice Address - Street 1:1462 W 84TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3363
Practice Address - Country:US
Practice Address - Phone:305-824-3641
Practice Address - Fax:305-557-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00100001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice