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General NPI Number Information
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NPI Number | 1063606986
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Entity Type | Individual
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Provider Name | GERALD VAN CAMMACK II D.D.S, M.S.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 2051 S WHEELER ST STE A
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City | JASPER
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State | TX
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Zip | 75951-5600
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Country | US
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Telephone | 409-384-8121
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Fax | 409-384-5337
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Provider Business Mailing Address
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Address Line | 2051 S WHEELER ST STE A
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City | JASPER
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State | TX
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Zip | 75951-5600
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Country | US
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Telephone | 409-384-8121
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Fax | 409-384-5337
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 20846
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License Number State | TX
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