Provider Demographics
NPI:1275806309
Name:CAMERON, PETER ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALLAN
Last Name:CAMERON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12420 EBNET CIR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8737
Mailing Address - Country:US
Mailing Address - Phone:952-939-4050
Mailing Address - Fax:
Practice Address - Street 1:12420 EBNET CIR
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8737
Practice Address - Country:US
Practice Address - Phone:952-939-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist