Provider Demographics
NPI:1972666923
Name:CAMERON, ANGELA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:R
Last Name:CAMERON
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 1:189 CORPORATE DRIVE
Mailing Address - Street 2:SUITE #20
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-928-8359
Mailing Address - Fax:423-282-6018
Practice Address - Street 1:189 CORPORATE DR
Practice Address - Street 2:SUITE #20
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2384
Practice Address - Country:US
Practice Address - Phone:423-928-8359
Practice Address - Fax:423-282-6018
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS79731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice