Provider Demographics
NPI:1710153499
Name:ALLEN, CAMILLE A (DDS)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 SPOTSYLVANIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2675
Mailing Address - Country:US
Mailing Address - Phone:540-891-5521
Mailing Address - Fax:540-891-9332
Practice Address - Street 1:10705 SPOTSYLVANIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2675
Practice Address - Country:US
Practice Address - Phone:540-891-5521
Practice Address - Fax:540-891-9332
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist