Healthcare Provider Details

I. General information

NPI: 1871780395
Provider Name (Legal Business Name): CAMERON HULSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CASSIA RD. SUITE 102
CARLSBAD CA
92009
US

IV. Provider business mailing address

2020 CASSIA RD. SUITE 102
CARLSBAD CA
92009-5959
US

V. Phone/Fax

Practice location:
  • Phone: 760-889-8180
  • Fax:
Mailing address:
  • Phone: 760-889-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number51079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: