Provider Demographics
NPI:1447368873
Name:CONKIN, CAMERON HUSTON (DDS)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:HUSTON
Last Name:CONKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6224
Mailing Address - Country:US
Mailing Address - Phone:317-882-2595
Mailing Address - Fax:317-882-5745
Practice Address - Street 1:8101 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6224
Practice Address - Country:US
Practice Address - Phone:317-882-2595
Practice Address - Fax:317-882-5745
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000077691223S0112X
IN12011582A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery