Healthcare Provider Details

I. General information

NPI: 1164356077
Provider Name (Legal Business Name): CAMERON ISAAC RADER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 E MAIN ST STE 104
PLAINFIELD IN
46168-2715
US

IV. Provider business mailing address

8800 NORTH ST APT 239
FISHERS IN
46038-2877
US

V. Phone/Fax

Practice location:
  • Phone: 317-707-7575
  • Fax:
Mailing address:
  • Phone: 317-498-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: