Provider Demographics
NPI:1528132669
Name:LITTLE, CAM WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAM
Middle Name:WAYNE
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAM
Other - Middle Name:WAYNE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1799 NW KINGS BLVD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1961
Mailing Address - Country:US
Mailing Address - Phone:541-754-6226
Mailing Address - Fax:541-757-1075
Practice Address - Street 1:1799 NW KINGS BLVD
Practice Address - Street 2:SUITE #10
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1961
Practice Address - Country:US
Practice Address - Phone:541-754-6226
Practice Address - Fax:541-757-1075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD71861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice