Provider Demographics
NPI: | 1366856262 |
---|---|
Name: | DR CAMERON AND ASSOCIATES III, PLLC |
Entity Type: | Organization |
Organization Name: | DR CAMERON AND ASSOCIATES III, PLLC |
Other - Org Name: | CAROLINASDENTIST.COM |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CLIFTON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CAMERON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 910-988-5483 |
Mailing Address - Street 1: | 1924 FINNEGAN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | FAYETTEVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28303-6819 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 300 GLENSFORD DRIVE |
Practice Address - Street 2: | |
Practice Address - City: | FAYETTEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28314 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-391-1502 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-06-18 |
Last Update Date: | 2014-06-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 8549 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |