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General NPI Number Information
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NPI Number | 1124747589
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Entity Type | Organization
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Legal Business Name | BROCK A. CAMERON, DMD, LLC
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 777 S NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8705
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Country | US
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Telephone | 314-965-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 209 GRAYLEAF CT
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City | WENTZVILLE
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State | MO
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Zip | 63385-6232
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Country | US
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Telephone | 618-977-4595
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BROCK ALEXANDER CAMERON
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Credential | DMD
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Telephone | 618-977-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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