1619644994 NPI number — CAMPBELL DENTAL ASSOCIATES P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619644994 NPI number — CAMPBELL DENTAL ASSOCIATES P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMPBELL DENTAL ASSOCIATES P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619644994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9937 MIRAMAR PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-2397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-260-9626
Provider Business Mailing Address Fax Number:
954-436-1072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9937 MIRAMAR PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-2397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-260-9626
Provider Business Practice Location Address Fax Number:
954-436-1072
Provider Enumeration Date:
08/25/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
BETH
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
954-260-9626

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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