Provider Demographics
NPI:1558841296
Name:SMALL, CAMERON JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:JAY
Last Name:SMALL
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 1:1173 RANCHO ENCINITAS DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7024
Mailing Address - Country:US
Mailing Address - Phone:760-525-0749
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE A302
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1351
Practice Address - Country:US
Practice Address - Phone:760-525-0749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist