Provider Demographics
NPI:1023804200
Name:MORALES ACEVEDO, CAMILO JOSE (DDS)
Entity type:Individual
Prefix:
First Name:CAMILO
Middle Name:JOSE
Last Name:MORALES ACEVEDO
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 1:2341 COLDWATER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1707
Mailing Address - Country:US
Mailing Address - Phone:310-890-9440
Mailing Address - Fax:
Practice Address - Street 1:706 W BEVERLY BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3626
Practice Address - Country:US
Practice Address - Phone:323-724-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist