Provider Demographics
NPI:1275798084
Name:CAMMACK, ELIZABETH DAWN (RDH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAWN
Last Name:CAMMACK
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 1:2617 LEGENDS WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2363
Mailing Address - Country:US
Mailing Address - Phone:859-341-2234
Mailing Address - Fax:859-341-4544
Practice Address - Street 1:2617 LEGENDS WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2363
Practice Address - Country:US
Practice Address - Phone:859-341-2234
Practice Address - Fax:859-341-4544
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3224124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist