Provider Demographics
NPI:1851479802
Name:BRACAMONTES, OSCAR A (DDS)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:A
Last Name:BRACAMONTES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:OSCAR
Other - Middle Name:A
Other - Last Name:BRACAMONTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91933-0999
Mailing Address - Country:US
Mailing Address - Phone:619-946-1071
Mailing Address - Fax:619-946-1071
Practice Address - Street 1:GERMAN GEDOVIUS 9505
Practice Address - Street 2:SUITE 104
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-634-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27637851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice