Provider Demographics
NPI:1619064391
Name:DWAYNE B. MCCAMISH DDS MS PC
Entity Type:Organization
Organization Name:DWAYNE B. MCCAMISH DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCAMISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:423-622-4173
Mailing Address - Street 1:4610 BRAINERD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411
Mailing Address - Country:US
Mailing Address - Phone:423-622-4173
Mailing Address - Fax:423-629-9889
Practice Address - Street 1:4610 BRAINERD ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-622-4173
Practice Address - Fax:423-629-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS22081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0016229Medicaid
549311OtherUNITED CONCORDIA
TN0015519OtherBC/BS