Provider Demographics
NPI:1255308789
Name:CAMP, BRIAN HUNTER (DDS MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HUNTER
Last Name:CAMP
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 BANDFORD WAY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2767
Mailing Address - Country:US
Mailing Address - Phone:919-876-4746
Mailing Address - Fax:919-876-5071
Practice Address - Street 1:8301 BANDFORD WAY
Practice Address - Street 2:SUITE 121
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2767
Practice Address - Country:US
Practice Address - Phone:919-876-4746
Practice Address - Fax:919-876-5071
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
90019OtherBCBS
NC8990019Medicaid
NC8990019Medicaid
2428613Medicare ID - Type Unspecified