Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 052979 | NY |
NPI | 1003016338 |
---|---|
Provider Name | Dr. Maria M Campos |
First Address | New York, NY 10003-2501 |
Second Address | New York, NY 10003-2501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 26/12/2013 |