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Organization
FAMILY DENTAL
Active
Organization
FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETICIA CAMACHO D.D.S. (PRESIDENR)
(714) 972-2506
Entity
Organization
Contact information
Practice address
700 W 19TH ST, SUITE C, COSTA MESA, CA 92627-3517
(714) 722-9027
(714) 722-9028
Mailing address
516 W 17TH ST, SUITE A, SANTA ANA, CA 92706-3677
(714) 972-2606
(714) 972-2607
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
55738
CA
305R00000X
Preferred Provider Organization
55738
CA
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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