Individual
DR. LUIS PEDRO MIRON CARCAMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1701 S PROSPECT AVE STE 201, CHAMPAIGN, IL 61820-7054
(217) 305-7980
Mailing address
1701 S PROSPECT AVE STE 201, CHAMPAIGN, IL 61820-7054
(217) 305-7980
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030115
IL
1223G0001X
General Practice Dentistry
DE60448654
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2044967
—
WA
Enumeration date
07/11/2011
Last updated
10/16/2024
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