Healthcare Provider Details

I. General information

NPI: 1619064391
Provider Name (Legal Business Name): DWAYNE B. MCCAMISH DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 BRAINERD ROAD
CHATTANOOGA TN
37411
US

IV. Provider business mailing address

4610 BRAINERD ROAD
CHATTANOOGA TN
37411
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-4173
  • Fax: 423-629-9889
Mailing address:
  • Phone: 423-622-4173
  • Fax: 423-629-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS2208
License Number StateTN

VIII. Authorized Official

Name: DR. DEWAYNE B. MCCAMISH
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 423-622-4173