Provider Demographics
NPI:1669968889
Name:CAMP COUNTY DENTAL PLLC
Entity type:Organization
Organization Name:CAMP COUNTY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AFUNRHE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OGHRE-IKANONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-600-2775
Mailing Address - Street 1:113 M L KING JR AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686
Mailing Address - Country:US
Mailing Address - Phone:903-856-3343
Mailing Address - Fax:
Practice Address - Street 1:113 M L KING JR AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686
Practice Address - Country:US
Practice Address - Phone:903-856-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty