Provider Demographics
NPI:1942844493
Name:CAMACHO, DANIEL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 SW 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-5450
Mailing Address - Country:US
Mailing Address - Phone:203-598-6362
Mailing Address - Fax:
Practice Address - Street 1:4330 SHERIDAN ST STE 201A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1406
Practice Address - Country:US
Practice Address - Phone:203-598-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN245971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics