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General NPI Number Information
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NPI Number | 1548803927
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Entity Type | Organization
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Legal Business Name | DR. CAMERON AND ASSOCIATES OF INDIAN TRAIL PLLC
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 5850 W HIGHWAY 74 STE 135
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-3441
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Country | US
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Telephone | 704-815-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 W HIGHWAY 74 STE 135
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-3441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PRACTICE OPERATIONS
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Name | GABRIELLE SMALLWOOD
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Credential |
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Telephone | 724-674-1022
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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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