Provider Demographics
NPI:1104213636
Name:CRITCHFIELD, CAMERON (DDS)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:CRITCHFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SOUTH 2000 EAST, SUITE 5900
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-581-8951
Mailing Address - Fax:801-585-6485
Practice Address - Street 1:1531 BLEISTEIN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3806
Practice Address - Country:US
Practice Address - Phone:307-587-0100
Practice Address - Fax:307-587-0105
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice