Healthcare Provider Details

I. General information

NPI: 1033973128
Provider Name (Legal Business Name): CAMERON DUTT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6456 S CENTRAL AVE
CLINTON WA
98236
US

IV. Provider business mailing address

5326 93RD PL NE
MARYSVILLE WA
98270-2648
US

V. Phone/Fax

Practice location:
  • Phone: 360-341-5606
  • Fax:
Mailing address:
  • Phone: 701-793-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAMERON DUTT
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 701-793-6516