Provider Demographics
NPI:1255441754
Name:CAMACHO ROLDOS, MAYRA (DMD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:
Last Name:CAMACHO ROLDOS
Suffix:
Gender:F
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:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0573
Mailing Address - Country:US
Mailing Address - Phone:787-255-3486
Mailing Address - Fax:
Practice Address - Street 1:CARR. 308 KM 0.0
Practice Address - Street 2:INT. CARR. 103 EDIF. #833
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-255-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice