Individual
DR. DIANA P CAMPOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
5647 MYRTLE AVE, RIDGEWOOD, NY 11385-4744
(718) 417-6300
Mailing address
5647 MYRTLE AVE, RIDGEWOOD, NY 11385-4744
(718) 417-6300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
058094
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04347682
—
NY
Enumeration date
08/11/2013
Last updated
02/16/2022
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