Healthcare Provider Details

I. General information

NPI: 1275100315
Provider Name (Legal Business Name): CAMERON MATHIAS AITKEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SYRACUSE AVE
NORFOLK NE
68701-2458
US

IV. Provider business mailing address

2602 J ST
OMAHA NE
68107-1643
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-8780
  • Fax:
Mailing address:
  • Phone: 402-733-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD1307
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: