Provider Demographics
NPI:1841322542
Name:CARCAMO, JORGE YAMIL (DMD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:YAMIL
Last Name:CARCAMO
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 1:134 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071
Mailing Address - Country:US
Mailing Address - Phone:201-933-1700
Mailing Address - Fax:201-355-4611
Practice Address - Street 1:134 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071
Practice Address - Country:US
Practice Address - Phone:201-933-1700
Practice Address - Fax:201-355-4611
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015616001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ09674784EMedicaid