Provider Demographics
NPI:1265171623
Name:CAMARGO, MELISSA (DMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CAMARGO
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 1:565 W QUINCY ST UNIT 1408
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2910
Mailing Address - Country:US
Mailing Address - Phone:270-996-7027
Mailing Address - Fax:847-453-4224
Practice Address - Street 1:231 N BOLINGBROOK DR STE A
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1960
Practice Address - Country:US
Practice Address - Phone:630-381-8281
Practice Address - Fax:847-453-4224
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist