Provider Demographics
NPI:1346352127
Name:CAMERON, GARY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:CAMERON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:LYNN
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:350 N COX ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203
Mailing Address - Country:US
Mailing Address - Phone:336-625-4216
Mailing Address - Fax:336-629-9317
Practice Address - Street 1:350 N COX ST
Practice Address - Street 2:SUITE 18
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-625-4216
Practice Address - Fax:336-629-9317
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
256208OtherANTHEM BCBS VA
91324OtherBCBS NCHC
5678OtherDELTA DENTAL
VI531576OtherUNITED CONCORDIA
91324OtherBCBS OF NC
NC8991324Medicaid