Provider Demographics
NPI:1861613689
Name:CAMERON, ERRICK L (DMD,MA,PC)
Entity type:Individual
Prefix:DR
First Name:ERRICK
Middle Name:L
Last Name:CAMERON
Suffix:
Gender:M
Credentials:DMD,MA,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 GLEN CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1519
Mailing Address - Country:US
Mailing Address - Phone:618-288-3838
Mailing Address - Fax:
Practice Address - Street 1:590 GLEN CROSSING RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1519
Practice Address - Country:US
Practice Address - Phone:618-288-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist