Provider Demographics
NPI:1972098341
Name:CAMACHO, YUSLEISY (DMD)
Entity type:Individual
Prefix:DR
First Name:YUSLEISY
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PIERS PARK LN APT 3308
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2888
Mailing Address - Country:US
Mailing Address - Phone:305-609-4755
Mailing Address - Fax:
Practice Address - Street 1:5 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1606
Practice Address - Country:US
Practice Address - Phone:978-977-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18579791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADN1857979OtherMASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH