Individual
DR. MICHAEL M CAMMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
780 W CHERRY LN, MERIDIAN, ID 83642-1617
(208) 888-4711
(208) 888-0308
Mailing address
780 W CHERRY LN, MERIDIAN, ID 83642-1617
(208) 888-4711
(208) 888-0308
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1507
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10009469
REGENCE BLUE SHIELD OF ID
ID
01
—
134932
TRI-CARE
ID
01
—
65987
BLUE CROSS OF ID
ID
01
—
D1507
DELTA DENTAL OF ID
ID
Enumeration date
08/01/2006
Last updated
07/09/2007
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