Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901018351 | MI |
NPI | 1013003847 |
---|---|
Provider Name | Dr. Jaime Andres Ocampo |
First Address | Battle Creek, MI 49015 |
Second Address | Quincy, MI 49082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |