Healthcare Provider Details

I. General information

NPI: 1821088428
Provider Name (Legal Business Name): STEPHEN G CAMERON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 YORK RD SUITE A201
LUTHERVILLE MD
21093-6240
US

IV. Provider business mailing address

1212 YORK RD SUITE A201
LUTHERVILLE MD
21093-6240
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-7755
  • Fax: 410-337-7922
Mailing address:
  • Phone: 410-337-7755
  • Fax: 410-337-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number06562
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: