Provider Demographics
NPI:1891063368
Name:CAMERON CONKIN DDS, ORAL AND MAXILLOFACIAL SURGEON, LLC
Entity Type:Organization
Organization Name:CAMERON CONKIN DDS, ORAL AND MAXILLOFACIAL SURGEON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:H
Authorized Official - Last Name:CONKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-882-2595
Mailing Address - Street 1:8101 SHELBY ST
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6224
Mailing Address - Country:US
Mailing Address - Phone:317-882-2595
Mailing Address - Fax:317-882-5745
Practice Address - Street 1:8101 SHELBY ST
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6224
Practice Address - Country:US
Practice Address - Phone:317-882-2595
Practice Address - Fax:317-882-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011582A261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery