Provider Demographics
NPI:1780021311
Name:MCCAMMON, DUSTIN (DMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:MCCAMMON
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 1:6328 CEDAR SAGE TRL
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7801
Mailing Address - Country:US
Mailing Address - Phone:801-472-7468
Mailing Address - Fax:
Practice Address - Street 1:14285 MIDWAY RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3622
Practice Address - Country:US
Practice Address - Phone:972-361-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice