Healthcare Provider Details

I. General information

NPI: 1063836716
Provider Name (Legal Business Name): DR CAMERON AND ASSOCIATES II, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CLUB POND RD
RAEFORD NC
28376-4000
US

IV. Provider business mailing address

2040 CLUB POND RD
RAEFORD NC
28376-4000
US

V. Phone/Fax

Practice location:
  • Phone: 910-391-1502
  • Fax: 910-795-1686
Mailing address:
  • Phone: 910-391-1502
  • Fax: 910-795-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8549
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8837
License Number StateNC

VIII. Authorized Official

Name: DR. CLIFTON CAMERON
Title or Position: OWNER
Credential: DDS
Phone: 910-998-5483