Provider Demographics
NPI:1326275751
Name:BIRCH, CAMERON W (DDS)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:W
Last Name:BIRCH
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 1:302 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-2017
Mailing Address - Country:US
Mailing Address - Phone:970-842-2858
Mailing Address - Fax:970-842-0691
Practice Address - Street 1:302 CAMERON ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-2017
Practice Address - Country:US
Practice Address - Phone:970-842-2858
Practice Address - Fax:970-842-0691
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104641223G0001X
TX246801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice