MEDICARE: DR. JEFFREY HOWARD CAMM DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DE00007908	WA

General Provider Information

NPI Number	:	1912981549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY HOWARD CAMM DMD

Provider Business Mailing Address
First Line	:	1501 REGENTS BLVD
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6098
Country	:	US
Telephone Number	:	253-564-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 REGENTS BLVD
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6095
Country	:	US
Telephone Number	:	253-564-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/08/2007

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