Provider Demographics
NPI:1649202458
Name:CAMPOS, FERNANDO (DDS)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:CAMPOS
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 1:1855 N UNIVERSITY DR
Mailing Address - Street 2:#1833
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-994-4949
Mailing Address - Fax:954-341-5271
Practice Address - Street 1:1855 N UNIVERSITY DR
Practice Address - Street 2:#1833
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:954-344-4949
Practice Address - Fax:954-341-5271
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN122331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice