Healthcare Provider Details

I. General information

NPI: 1104575067
Provider Name (Legal Business Name): ROSS EVAN CAMIEL DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ELSBREE ST
FALL RIVER MA
02720-7212
US

IV. Provider business mailing address

725 ALBANY ST FL 6
BOSTON MA
02118-3549
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-1069
  • Fax:
Mailing address:
  • Phone: 617-414-7558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number1022800
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN10000686
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: