Provider Demographics
NPI:1720590920
Name:CAMERON, DANE
Entity Type:Individual
Prefix:MR
First Name:DANE
Middle Name:
Last Name:CAMERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LINCOLN ST
Mailing Address - Street 2:2ND FLOOR, ATTN: CREDENTIALS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98327
Mailing Address - Country:US
Mailing Address - Phone:253-968-4079
Mailing Address - Fax:
Practice Address - Street 1:9119 MIL PARK AVE
Practice Address - Street 2:FULTON DENTAL
Practice Address - City:JBLM
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-966-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1454810640OtherUS ARMY