Provider Demographics
NPI:1518259191
Name:CAMEN, MARY LOUISE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:CAMEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E. CASS RD
Mailing Address - Street 2:
Mailing Address - City:MUNGER
Mailing Address - State:MI
Mailing Address - Zip Code:48747-9723
Mailing Address - Country:US
Mailing Address - Phone:989-892-9479
Mailing Address - Fax:
Practice Address - Street 1:575 E. CASS ROAD
Practice Address - Street 2:
Practice Address - City:MUNGER
Practice Address - State:MI
Practice Address - Zip Code:48747-9723
Practice Address - Country:US
Practice Address - Phone:989-892-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902002909124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist