Provider Demographics
NPI:1740837632
Name:PRIVOTT, CAMERON MCALISTER (DDS)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:MCALISTER
Last Name:PRIVOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 GAMMON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8129
Mailing Address - Country:US
Mailing Address - Phone:252-813-6944
Mailing Address - Fax:
Practice Address - Street 1:6335 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5103
Practice Address - Country:US
Practice Address - Phone:843-552-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice