Provider Demographics
NPI:1790356095
Name:CARD, CAMELLA (DDS)
Entity Type:Individual
Prefix:
First Name:CAMELLA
Middle Name:
Last Name:CARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 DAVID O DODD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2746
Mailing Address - Country:US
Mailing Address - Phone:501-312-7576
Mailing Address - Fax:501-502-2052
Practice Address - Street 1:13600 DAVID O DODD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2746
Practice Address - Country:US
Practice Address - Phone:501-312-7576
Practice Address - Fax:501-502-2052
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR45371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice