Camille Vera Gannam, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

103287 Issued in CA

Practice address

11253 Brockway Rd Ste 205
Truckee, CA 96161-3360

Phone

(530) 414-1966

NPI assigned

Apr 8, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1831518760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 BASQUE DR",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961613912",
            "telephone_number": "530-414-1966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11253 BROCKWAY RD STE 205",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961613360",
            "telephone_number": "530-414-1966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1125 Ave Of The Oaks Unit 161",
            "address_purpose": "LOCATION",
            "city": "Sparks",
            "state": "NV",
            "postal_code": "894314913",
            "country_code": "US",
            "telephone_number": "775-346-8988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANNAM",
        "first_name": "CAMILLE",
        "middle_name": "VERA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-08",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "103287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Marie Friedman
• Matthew Joseph Friedman, MS, AMFT
• Fuel Lab
• Alexa Marissa Pliskow Funk, MSW, LCSW
• Bonni Rae Funk, MA, LMHC, LPCC
• Alison C Ganong, MD
• Richard B Ganong
• Tammy A Garbarino, LMFT
• Jennifer Gariepy, DPT
• Gateway Mountain Center

• Pediatric Dentistry in Truckee, CA
• Providers in Truckee, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.