Jolmiry Adriana Campos
Individual provider Active NPI Dentist · Holbrook, MA
NPI 1487419925 · NPPES record last updated Sep 11, 2024
Key facts
- NPI
- 1487419925
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN10000480 (MA)
- Practice address
- 175 N Franklin St
Holbrook, MA 02343-1171 - Phone
- (781) 423-1370
- NPI assigned
- Feb 14, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN10000480 | MA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MA | ||
| Dentist |
122300000X | DN10000480 | MA | Yes |
Addresses
Primary practice location
175 N Franklin St
Holbrook, MA 02343-1171
Mailing address
89 E Dedham St Apt 317
Boston, MA 02118-2658
Phone (617) 991-3548
Other practice location 1
34 Salem St Unit 102
Medford, MA 02155-3207
Phone (781) 391-2988
Other providers in Holbrook, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.