Provider Demographics
NPI:1750279600
Name:KWIATKOUSKI, CAMERON ADAM (DMD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ADAM
Last Name:KWIATKOUSKI
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 1:5009 DELACROIX RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3921
Mailing Address - Country:US
Mailing Address - Phone:310-740-5017
Mailing Address - Fax:
Practice Address - Street 1:28901 S WESTERN AVE STE 135
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0824
Practice Address - Country:US
Practice Address - Phone:310-750-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS111651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist