Provider Demographics
NPI:1104292283
Name:REIS PEREIRA DI GIORGIO, CAMILA
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:REIS PEREIRA DI GIORGIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7070
Mailing Address - Country:US
Mailing Address - Phone:754-225-1001
Mailing Address - Fax:754-225-1001
Practice Address - Street 1:1261 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7070
Practice Address - Country:US
Practice Address - Phone:754-225-1001
Practice Address - Fax:754-225-1001
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN230741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice