Healthcare Provider Details

I. General information

NPI: 1477363091
Provider Name (Legal Business Name): CLIFTON S. CAMERON, D.D.S. III - LEESVILLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 LEESVILLE RD STE 202
RALEIGH NC
27613-7603
US

IV. Provider business mailing address

9305 LEESVILLE RD STE 102
RALEIGH NC
27613-7603
US

V. Phone/Fax

Practice location:
  • Phone: 910-260-5296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MARINA RAMIREZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 301-202-4724