Provider Demographics
NPI:1528128998
Name:CAMERON, DUSTIN (DENTIST DMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:CAMERON
Suffix:
Gender:M
Credentials:DENTIST DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MADISON
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-848-0014
Mailing Address - Fax:708-848-0415
Practice Address - Street 1:1015 MADISON
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-848-0014
Practice Address - Fax:708-848-0415
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice