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General NPI Number Information
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NPI Number | 1033320957
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Entity Type | Individual
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Provider Name | CAMERON JUDD EGBERT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 642 KIRBY LN STE 101
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City | SPANISH FORK
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State | UT
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Zip | 84660-5753
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Country | US
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Telephone | 801-798-9500
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Fax | 801-798-5466
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Provider Business Mailing Address
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Address Line | 8426 STICKNEY AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-2809
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Country | US
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Telephone | 801-450-2019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7835316
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License Number State | UT
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