Provider Demographics
NPI:1154469641
Name:CAMP, DAVID LEE
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:CAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:LEE
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1452 OAK SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3969
Mailing Address - Country:US
Mailing Address - Phone:770-565-4481
Mailing Address - Fax:
Practice Address - Street 1:6111 PEACHTREE DUNWOODY RD NE STE A101
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4577
Practice Address - Country:US
Practice Address - Phone:770-393-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist