Healthcare Provider Details

I. General information

NPI: 1245825918
Provider Name (Legal Business Name): REBECCA CAMERON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E JEFFERSON AVE STE 70
DETROIT MI
48214-3730
US

IV. Provider business mailing address

7633 E JEFFERSON AVE STE 70
DETROIT MI
48214-3730
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600820
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: