Provider Demographics
NPI:1699841445
Name:CAMERON, BURCH GILL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BURCH
Middle Name:GILL
Last Name:CAMERON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 PRINCETON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9069
Mailing Address - Country:US
Mailing Address - Phone:706-322-2503
Mailing Address - Fax:706-322-0240
Practice Address - Street 1:5605 PRINCETON AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9069
Practice Address - Country:US
Practice Address - Phone:706-322-2503
Practice Address - Fax:706-322-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00084081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics