Cameron Dezham, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

45243 Issued in CA

Practice address

216 De Anza Blvd
San Mateo, CA 94402-3913

Phone

(650) 524-4855

Fax

(650) 524-4859

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225065600000",
    "number": "1093926677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 DE ANZA BLVD",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023913",
            "telephone_number": "650-524-4855",
            "fax_number": "650-524-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 DE ANZA BLVD",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023913",
            "telephone_number": "650-524-4855",
            "fax_number": "650-524-4859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZHAM",
        "first_name": "CAMERON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2008-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "943347144",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Desilva
• Gardy F Desroches, RN
• Serena Deverich, NP
• Geeta Devjani
• Endiya Devoe
• Anish Dhamija, MD
• Gagandeep Kaur Dhillon
• Diane Au, L.Ac.
• Andrew Jason Dias, DC
• Erika Diaz Rueda

• General Practice Dentistry in San Mateo, CA
• Providers in San Mateo, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.