Healthcare Provider Details

I. General information

NPI: 1962558346
Provider Name (Legal Business Name): JOE H CAMP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PROVIDENCE ROAD
CHARLOTTE NC
28207
US

IV. Provider business mailing address

130 PROVIDENCE ROAD
CHARLOTTE NC
28207
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-1444
  • Fax: 704-377-1451
Mailing address:
  • Phone: 704-377-1444
  • Fax: 704-377-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3019
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: