Healthcare Provider Details

I. General information

NPI: 1194402602
Provider Name (Legal Business Name): CAMILLE NICOLE BANSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7028 WRIGHTSVILLE AVE
WILMINGTON NC
28403-3655
US

IV. Provider business mailing address

7028 WRIGHTSVILLE AVE
WILMINGTON NC
28403-3655
US

V. Phone/Fax

Practice location:
  • Phone: 774-278-0143
  • Fax:
Mailing address:
  • Phone: 774-278-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: