Provider Demographics
NPI:1902889975
Name:MCCAMISH, DEWAYNE B (DDS, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:DEWAYNE
Middle Name:B
Last Name:MCCAMISH
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4610 BRAINERD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3835
Mailing Address - Country:US
Mailing Address - Phone:423-624-6425
Mailing Address - Fax:423-629-9889
Practice Address - Street 1:4610 BRAINERD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3835
Practice Address - Country:US
Practice Address - Phone:423-624-6425
Practice Address - Fax:423-629-9889
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1022081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0016229Medicaid