Provider Demographics
NPI:1730326851
Name:CAMPOS-BOTELLO, SANDRA (RDH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:CAMPOS-BOTELLO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1132
Mailing Address - Country:US
Mailing Address - Phone:361-225-3550
Mailing Address - Fax:
Practice Address - Street 1:535 GORDON ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2535
Practice Address - Country:US
Practice Address - Phone:361-855-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10648124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist