Provider Demographics
NPI:1538209846
Name:VANDEVANTER, CAMILLE MARIE (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:MARIE
Last Name:VANDEVANTER
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33507 - 9TH AVE. S. BUILDING G
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-661-7228
Mailing Address - Fax:253-661-9508
Practice Address - Street 1:33507 - 9TH AVE. S. BUILDING G
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-661-7228
Practice Address - Fax:253-661-9508
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA64441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics