Provider Demographics
NPI:1417029208
Name:ELMER, CAMERON JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:JOHN
Last Name:ELMER
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 1:104 N WALNUT ST
Mailing Address - Street 2:PO BOX478
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-1347
Mailing Address - Country:US
Mailing Address - Phone:563-422-5629
Mailing Address - Fax:
Practice Address - Street 1:104 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1347
Practice Address - Country:US
Practice Address - Phone:563-422-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA69701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1217299Medicaid