Provider Demographics
NPI:1760827992
Name:DEHAAN, CAMERON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:DEHAAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 U.S. 131 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-775-9797
Mailing Address - Fax:231-775-9793
Practice Address - Street 1:7800 US 131 SOUTH
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-775-9797
Practice Address - Fax:231-775-9793
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI2901020906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program