Individual provider Active NPI

Camille J Zelen, DDS

  • Dentist
  • Duluth, MN
National Provider Identifier
1104078716
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D12746 Issued in MN
Practice address
1624 Woodland Ave
Duluth, MN 55803-2628
Phone
(218) 464-5222
NPI assigned
Oct 14, 2008
Last updated
Mar 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6796 NE
Dentist 122300000X D12746 MN Primary

Addresses

Primary practice location

1624 Woodland Ave
Duluth, MN 55803-2628

Mailing address

1624 Woodland Ave
Duluth, MN 55803-2628
Phone (218) 464-5222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150630001971 WI Order and Referring Only - DentistPractitioner - Dentist 0042522211

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6796NEMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Camille Zelen DDS PA PastSince Jul 1, 2013 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1104078716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558032628",
            "telephone_number": "218-464-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558032628",
            "telephone_number": "218-464-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELEN",
        "first_name": "CAMILLE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-14",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "6796",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.