Provider Demographics
NPI:1427920230
Name:CAMACHO, EMILY VANESSA (DDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VANESSA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 W 142ND ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6835
Mailing Address - Country:US
Mailing Address - Phone:310-948-7718
Mailing Address - Fax:
Practice Address - Street 1:2710 CARSON ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4051
Practice Address - Country:US
Practice Address - Phone:562-275-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1123101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice