Active NPI
Cameron Clark, DMD
- Dentist
- Corvallis, OR
National Provider Identifier
1912137282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9301
- Practice address
- 869 NW 23Rd St
Corvallis, OR 97330-4307 - Phone
- (541) 757-1829
- NPI assigned
- Jul 21, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9301 | OR | Primary |
Addresses
Primary practice location
869 NW 23Rd St
Corvallis, OR 97330-4307
Mailing address
3002 Sunrose CT
Philomath, OR 97370-9427
Phone (503) 502-5752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9301 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Health PC | Past | 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 and National Provider Directory roles.
-
- General Practice Dentistry
- Corvallis, OR
- NPI 1922333988
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248134400000",
"number": "1912137282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3002 SUNROSE CT",
"city": "PHILOMATH",
"state": "OR",
"postal_code": "973709427",
"telephone_number": "503-502-5752",
"fax_number": "541-757-8628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "869 NW 23RD ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973304307",
"telephone_number": "541-757-1829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CAMERON",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-21",
"last_updated": "2009-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "9301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.