Provider Demographics
NPI:1407386683
Name:CAMERON, KRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CASA BUENA DR STE 4
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1710
Mailing Address - Country:US
Mailing Address - Phone:415-924-4435
Mailing Address - Fax:415-924-7421
Practice Address - Street 1:81 CASA BUENA DR STE 4
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1710
Practice Address - Country:US
Practice Address - Phone:415-924-4435
Practice Address - Fax:415-924-7421
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice