Bruce Anthony Camp, DMD
Individual provider Active NPI Dentist · Villa Rica, GA
NPI 1740409606 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1740409606
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- GA9911 (GA)
- Practice address
- 50 Community SQ Blvd
Villa Rica, GA 30180-0100 - Phone
- (770) 459-1663
- Fax
- (770) 459-8005
- NPI assigned
- Apr 25, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL3921 | AL | MD | Dentist |
| GA9911 | GA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | AL3921 | AL | |
| Dentist | 122300000X | GA9911 | GA | Yes |
Addresses
Primary practice location
50 Community SQ Blvd
Villa Rica, GA 30180-0100
Mailing address
PO Box 100
50 Community SQ Blvd
Villa Rica, GA 30180-0100
Phone (770) 459-1663
Other providers in Villa Rica, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.