Provider Demographics
NPI:1659957926
Name:BIRRELL, CAMERON (DDS)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:BIRRELL
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 1:223 N 890 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4956
Mailing Address - Country:US
Mailing Address - Phone:801-636-5838
Mailing Address - Fax:
Practice Address - Street 1:2120 S 700 E STE I
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2568
Practice Address - Country:US
Practice Address - Phone:385-257-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11831287-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice