Provider Demographics
NPI:1548221401
Name:KAMINSKI, PAMELA (DMD PEDIATRIC DENTIS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:DMD PEDIATRIC DENTIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CALLE PORTAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-459-3011
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:4525 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2232
Practice Address - Country:US
Practice Address - Phone:520-459-3011
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD24131223P0221X
AZD0094381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ765206Medicaid
NM43172890Medicaid