Provider Demographics
NPI:1740409606
Name:CAMP, BRUCE ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ANTHONY
Last Name:CAMP
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:PO BOX 100
Mailing Address - Street 2:50 COMMUNITY SQ BLVD
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-0100
Mailing Address - Country:US
Mailing Address - Phone:770-459-1663
Mailing Address - Fax:770-459-8005
Practice Address - Street 1:50 COMMUNITY SQ BLVD
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-0100
Practice Address - Country:US
Practice Address - Phone:770-459-1663
Practice Address - Fax:770-459-8005
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL3921122300000X
GAGA9911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist