Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1962790006 Individual Practitioner Male Practitioner

Luis Pedro Miron Carcamo

Dentist • Champaign, IL

Professional Overview & Biography Verified Profile Summary

Luis Miron Carcamo is a registered healthcare professional specializing in Dentist in Champaign, IL. Practice services are available at 1701 S PROSPECT AVE STE 201 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1701 S Prospect Ave Ste 201

Champaign, IL 618207054

Telephone 2173057980

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Champaign, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 12.1 Yrs
Regional Practice Density
44 Specialists

Practicing in Champaign, IL (4751 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-10-16
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License IL 019030115

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License WA DE60448654

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
2044967 (WA)

Secondary Practice Locations

1515 E Columbia St

Othello, WA 993441846

Phone: 5094885256

1051 Columbia Ave

Connell, WA 993268702

Phone: 5094885256

601 Government Rd

Mattawa, WA 993495120

Phone: 5094885256

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

17 Historical Events
📍
Updated Practice Location October 16, 2024

Registered at 1701 S PROSPECT AVE STE 201, CHAMPAIGN, IL 618207054 (Tel: 2173057980)

📍
Updated Business Mailing Address October 16, 2024

Registered at 1701 S PROSPECT AVE STE 201, CHAMPAIGN, IL 618207054 (Tel: 2173057980)

📍
Updated Practice Location April 25, 2023

Registered at 1051 COLUMBIA AVE, CONNELL, WA 993268702 (Tel: 5094885256)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 25, 2023

Dentist (License #DE60448654 in WA)

📍
Updated Practice Location February 17, 2020

Registered at 1515 E COLUMBIA ST, OTHELLO, WA 993441846 (Tel: 5094885256)

📍
Updated Business Mailing Address February 17, 2020

Registered at 1515 E COLUMBIA ST, OTHELLO, WA 993441846 (Tel: 5094885256)

NPI Profile Active February 07, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location February 07, 2017

Registered at 140 E MAIN ST, OTHELLO, WA 993441040 (Tel: 5094885256)

📍
Updated Business Mailing Address February 07, 2017

Registered at 1140 W EDISON STREET, CONNELL, WA 99326 (Tel: 5094885256)

👤
Provider Name / Credentials Updated February 07, 2017

Recorded as LUIS MIRON CARCAMO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 07, 2017

Dentist (License #DE60448654 in WA)

NPI Profile Active July 17, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location July 17, 2014

Registered at 263 FARMINGTON AVE, FARMINGTON, CT 060300001 (Tel: 8606792000)

📍
Updated Business Mailing Address July 17, 2014

Registered at 29 WELLINGTON DR, FARMINGTON, CT 060323208 (Tel: 8608164396)

👤
Provider Name / Credentials Updated July 17, 2014

Recorded as LUIS MIRON CARCAMO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 17, 2014

Dentist (License #011121 in CT)

🟢
Initial NPI Registration & Enumeration July 11, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1962790006
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 11, 2011
Last Update: October 16, 2024
Sole Proprietor: No

Mailing Address

1701 S Prospect Ave Ste 201

Champaign, IL 618207054

Phone: 2173057980

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.